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High Risk Ob Transports


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#1 Idahonurse

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Posted 17 November 2009 - 02:33 AM

Hello,

My transport team is starting to transport High risk OB patients. What medications and equipment should we carry? Right now we have MgSO4, Pitocin and Trandate. Anybody transport in an AS350?

Karol Stafford, RN
Boise, Idaho
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#2 Gila

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Posted 17 November 2009 - 03:02 AM

Hydralazine would be a good consideration along with terbutaline. Are you able to do fetal monitoring? Additionally, I like to use Zofran over Phenergan. While my conclusion is based on rather weak evidence, I feel that going with Zofran may be a little safer, especially in the first trimester.

I would not recommend flying high risk OB in an AS350. You typically have limited access. I have herd of people reverse loading patients; however, this limits access to the airway. A bad situation any way you figure when using an AS350 for this purpose.
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Christopher Bare
"Non fui, fui, non sum, non curo "

#3 Mike Mims

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Posted 17 November 2009 - 05:52 AM

I agree with Gila about transporting High Risk OB in a AS350, at a little under 100 cubic feet, there's just not enough room.
It also depends on your definition of "high risk." If you are referring to a medical condition that classifies the pt high-risk (Cardiac, Diabeties, HTN) than an AS350 maybe sufficient.
However, if they are high-risk due to a complication (premature birth, abruption, eclampsia) in an A-star, NO WAY I'd feel comfortable. If you fly head forward you loose airway capabilities, feet forward........well you get it.

We fly a 230 and rarely fly high-risk OB due to complications and NEVER active labor.

But, if you have no control over what an administrator has decided what you SHOULD transport I'd recommend:
Just about two of everything (one for mom and one for baby)
Cardiac monitors
Etco2
Some type of electronic fetal monitoring system
Doppler
Blood and/or blood products
IV fluid warmer
5% D/W
Slouset
Butterfly needles
Thermometer
Equipment for UVC
OB kit x 2
RNC-OB (Registered Nurse Certified in Obstetrics) someone who works with High-risk OB/GYN, and neonates (preferably from a level III or IV NICU).


Drugs The ones Gila listed are good, plus
Surfactant/Survanta
Ativan
Versed
D10
Procardia
Dexamethasone


This is a research project that 2 of our ED physicians, our medical director and our former program director did in 2001
A national survey of the air medical transport of high-risk obstetric patients
(Airmed Journal, March 2001, Volume 20, Issue 2 pages 17-20)
(Annals of Emergency Medicine, Volume 34, Issue 4)


Abstract
Introduction: Air medical transport of high-risk obstetric (HROB) patients can be accomplished and advantageous for neonate survival and maternal morbidity. A survey of U.S. helicopter air medical programs was conducted to determine the frequency and current practices of HROB transport.

Methods: Each program was contacted by telephone, and air medical personnel were asked to answer 12 questions based on personal experience and statistics compiled by their programs.

Results: Of the 203 programs surveyed, 133 (66%) provided responses. The mean number of HROB transports was 45.6 per year (4.6% of the mean 995 total transports). Although 83% of the responding programs used the standard flight crew during the HROB transport, only 52% required crew members to maintain neonatal resuscitation certification. Only 56% of the aircraft allow pelvic access in the normal patient configuration. While only 22% of programs have specific HROB launch (dispatch) protocols, 50% reported having obstetricians involved in dispatching flights, and 84% carry tocolytic agents in their drug kit. The greatest concerns included in-flight delivery (60%), inadequate fetal monitoring (6%), and inexperience (5%).

Conclusion:While HROBs account for 5% of air medical flights, many programs appear to be poorly prepared for these patients.


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Mike Mims

Aircare

University of Mississippi Medical Center


#4 JPatterson

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Posted 17 November 2009 - 02:33 PM

I would also add Nifedipine for tocolysis. It has become first line over Mag and Terb on my CCT for high risk OB.

Maybe some duct tape and dermabond if you can't access the pelvis :P
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Jeff Patterson NREMT-P