RE: High Risk OB dilemna

["Doerr, Russell" <doerrr@rcbhsc.wvu.edu>]

Dave,
Our standard flight team transports high risk OB patients.  We fly our
standard team with a neonatal nurse practitioner for any patient less than 1
month corrected age.  I spend quite a bit of my work time when I'm not
flying in our NICU.  I attend resuscitations in house and assist in the unit
as an educational tool to me.  I have intubated quite a few 26 week infants
so I do feel very comfortable in my abilities to resuscitate if needed.  I
was impressed by and agree with the response by Pam Adams.  A 26 week
preemie would almost fall out because of their size.
My concern if delivery occurred in this situation would be how to keep this
infant warm.  No matter what time of year, this child would be certain to be
cold if delivered in the air.  It would also be best to have 2 team members
to resuscitate the infant so who would care for the mother?  Our program has
policies against transporting a mother with  this kind of exam.  Our medical
command physician would refuse the transport for medical reasons before we
had to make the decision.
I am pretty sure our neonatologists would agree that this transport should
be turned down.  We would probably offer to assist with resuscitation of the
infant at the referring and then transport the infant if needed.
Fly Safe,
Rusty

-----Original Message-----
From: Dave Sharpe [mailto:dsharpe@calstar.org]
Sent: Sunday, August 03, 2003 2:20 PM
To: flightmed@flightweb.com
Subject: High Risk OB dilemna


Ok folks, here's a scenario for you.  Your service flies a BO-105 
aircraft, and has an agreement with a local OB receiving facility to 
provide transport for high-risk OB patients.  On these flights, you 
send the aircraft with one Flight Nurse to the receiving facility to 
pick up a Labor and Delivery Transport Nurse as part of your team, then 
respond to the sending facility 20 minutes away (90 minutes by ground). 
  Upon arrival, you find  a 26 week pregnant, G1P0 patient whose cervix 
is dilated to 10 cm with intact but bulging membranes.  She came in the 
day prior with contractions which were controlled with a MagSo4 drip at 
3gm/hr.  She is no longer having contractions.  The sending physician 
wants her transferred to the receiving specialty center to manage her 
pre-term labor, but does have the capability to resuscitate a preemie 
newborn if necessary.
1.)	Would you transport this patient?
2.)	For the sake of discussison, lets stipulate that you're not 
comfortable with transporting the patient, but the L&D specialty nurse 
and the receiving Perinatologist feel the patient is stable enough to 
transport by air, and is not in danger of delivering precipitously 
enroute.  Given this information, would you then transport the patient?


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