Critical Care Scenarios
Episode 24: Rural retrieval medicine with Minh Le Cong
Scene management, logistics, and stabilization of a blunt trauma patient in the Australian outback with Dr. Minh Le Cong (@ketaminh), rural GP and retrieval physician for the Royal Flying Doctor Service and host of the PHARM podcast.
* If there is reasonable suspicion of the presence of a pneumothorax (of any size), have a low threshold to empirically decompress it before bringing the patient to altitude. Needles are okay, chest tubes are probably better.* Hemothorax may be a soft reason to avoid chest decompression, which could conceivable remove the tamponading effect of intrapleural pressure.* Consider ketamine for a neuro-stable induction.* Abdominal aortic compression may be a salvage temporizing measure for penetrating abdominal/pelvic trauma where surgical intervention is delayed.* Packaging depends on how much time you can afford to spend on scene. Simplify spinal precautions; consider measures like vacuum boards.* All gasses expand at altitude and contract with descent. Think ETT cuffs, vacuum mattresses, pneumothoraces, etc, all which may shift and change size during travel.* Whether practiced by paramedics, nurses, physicians, APPs, or others, transport and prehospital medicine is fundamentally the same business. The invasiveness of management may vary, but the core principles and the bulk of the approach does not. The addition of point-of-care ultrasound may be the biggest added value that would require higher levels of training.