CASE 31
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Relevant information
Questions
31.1 What further information is required in formulating a retrieval plan?
31.2 What difficulties can be expected in the clinical assessment and management of this patient?
31.3 Assuming it is appropriate to do so, how should she be transported to the retrieval destination?
Discussion
31.1 Clinical
This patient has clearly overwhelmed the level of clinical care available to her at her current location and therefore critical care retrieval is required. Attempting to understand the severity of both her chronic morbidity (a surrogate measure of her physiologic capacity to cope with acute critical illness) and her current presentation will not alter this fact. However, the early clinical advice given and clinical plans for the responding PHR team may well alter with further information. Clinical questions may include:
Usual level of physical functioning?
• Is she house or even bed bound?
• Does she function at the limit of her physiologic reserve even when ‘well’?
• Is there any exercise capacity?
Time course of current illness?
• Is this the clinical picture of sudden heart failure or progressive pneumonia?
• If the latter, non-invasive ventilation is unlikely to be adequate for longer term support and early invasive ventilation is indicated.
Current required fractional inspired oxygen
• High requirements at current ground level will be problematic should cabin press-urisation not be possible (see Case 24). This may impact on transport platform selection.
Clinical investigations available to aid diagnosis?
• Chest radiograph?
• Point of care blood analysis?
Skill and knowledge at referral hospital
• If early intervention is advised, do the staff have the clinical capacity to manage such a complex patient?
Logistics
Regional variation will guide a retrieval coordinator in this regard. An in-depth knowledge of local transport assets (including their availability and patient weight limitations) and regional geography is required. Knowledge of available specialist bariatric patient transport equipment, platforms or even teams may also impact on the plan. In broad terms (and in addition to the usual logistic considerations when coordinating a retrieval response), the considerations include:
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