Pediatric emergency medicine trisk 0335 0335

the patient movement should be coordinated by a team leader, similar to the
coordinated effort required to move a patient with a potential cervical spine
injury. Precautions, such as planned, temporary disconnection of the ventilator
from the endotracheal tube, may need to be considered during these moves.
Finally, the patient must be carefully reassessed immediately after each
movement. The team must be assured that the airway is stable, immobilization is
secure (if appropriate), and potentially lifesaving tubes, lines, and medications
have not become dislodged or disrupted.
Monitoring is imperative during the transport process. Observation and
palpation may be hindered by patient position relative to the provider within the
vehicle. This may be especially evident in a transport helicopter. Auscultation
may also be impaired in a noisy transport environment. The air transport
environment may be 50% louder than a comparable ground transport. Therefore,
more reliance is placed on sophisticated monitoring tools, including
cardiorespiratory parameters, pulse oximetry, capnography, gas delivery monitors
with audible and visual alarms, ultrasound, and point-of-care laboratory testing.

ALTITUDE PHYSIOLOGY AND THE AIR MEDICAL
ENVIRONMENT
When pediatric patients are transported by helicopter or FW aircraft, one must be
cognizant of issues regarding altitude physiology. An increase in altitude brings
with it a decrease in ambient oxygen as well as the potential for an increase in the
size of air spaces. For most patients, however, these are not major issues. For
patients with severe hypoxia at sea level, diving injuries, or large, enclosed
pockets of air, air transport can be dangerous.
Two gas laws are important in the transport process. Boyle Law states that with
a constant temperature, the volume of a gas varies inversely with the pressure (P1
V1 = P2 V2 ) ( Fig. 11.10 ). As altitude increases, barometric pressure decreases;
therefore, the volume of the gas increases. Dalton Law (the law of partial
pressure) says that the partial pressure of a gas mixture is the sum of all the partial
pressures of the gas within the mixture (PT = P1 + P2 + P3 …) ( Fig. 11.11 ). For

example, the total pressure of air is 1. The partial pressure of nitrogen is 0.78,
oxygen is 0.21, and other gases is 0.01. The partial pressure of oxygen will
always be 21%. At higher altitudes, air becomes less dense and the partial
pressure of oxygen, while still 21%, offers diminished oxygen availability.