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Neonatal Transfer by road

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					Neonatal Transfer by road

      David Bresler
        METRO
                  Objectives

• What is a neonate?
• Highlight the logistics required for safe
  transportation of the neonate.
• The checks done preparing for transportation.
• Which type of illnesses are commonly
  transferred
  (high risk)
  The receiving hospital
            What is a neonate?

• Neonate - 1st 28 days,    full term 38-40wks

• Premature Neonate - < 38 wks / < 2,5kgs

• Post term – born after 42wks
                Neonates vitals

•   Pulse Rate  80 – 160 (acceptable)
•   Haemoglobin       17 g/dl
•   Respiration       30 – 80
•   Posture           flexed
•   Sight             can distinguish light & dark
•   Hearing           well established at birth
          The medium of travel

• Lets state the obvious…

• Code 10 drivers licence.

• Competent personnel.

• Enough petrol.

• Roadworthy vehicle.
                Equipment

• Adequate, functioning equipment (suction,
  ECG with additional batteries and paper,
  charging or charged dinamap)

• Enough 02 for the journey.

• A working heater (cold weather)
                Equipment

• Syringe driver for specific drug dosage
  administration.

• Ventilator with serviced connections and
  tubing.

• Telethermometer.
               Equipment

• Whenever using ventilator, ALWAYS have
  a BVMR in incubator, connected to a
  separate, closed, small 02 cylinder, in
  case of ventilator malfunction.
                The incubator

•   Transportable.
•   Light weight.
•   Must be able to be battery supported.
•   Must have accessible portholes.
•   Must fit onto ambulance stretcher.
                Incubator

• Must have power access to ambulance.
• While out of ambulance, incubator should
  have either charged-up extended battery
  life, or back-up portable battery support
  system.
                Preparation

• Pre-warm neonatal mattress on the way to
  transferring hospital, by inverting mattress
  onto base of incubator, and then place it
  …
     Preparation

   “right way around”
         on scene.

When infant is placed into
 “bed”, it will be nicely
      warmed up.
                Preparation

• Remember to pre-clean incubator with
  soap and warm water, and then
  disinfectant solution, before and after
  conveying infant.
          Preparing for transport

Vitals:

Respiratory rate     Check setting on
 ventilator, and set
               babylog accordingly.

NB: Always keep a close eye on babies
 clinical picture and vitals.
            Preparing for transport
Easy formula to set ventilator if no parameters to
  work on:

( 60 seconds / respiratory rate / I+E = Inspiratory
   time)
If I:E is 1:1 divide by 2, if I:E 1:2, divide by 3, etc.
Once you have inspiratory time, work out
   expiratory
time, based on ratio.

Flow/ sec = Tidal volume / Inspiratory time.
On ventipac : Inspiratory + expiratory times + flow/
  litres per sec = minute volume.
             Preparing for transport
Blood pressure
( gestational age of prem baby same as M.A.P. on
   Dinamap)

Temp              36,5 C

Heart rate        120-160 normal

HGT               3,5 mmol/l min.
                  Remember to dilute to 12,5 % if low.
                  (For every 1 ml of 50% Dextrose
                  / kg, dilute with 3mls sterile water or
                  0.9 % sodium chloride.
            Prepare for transport

Check ID, compare with mothers folder.

IV fluids ( Neonatalyte)

History

Reason for transfer

Escorts?
            High risk neonate

• Hypoxia

• Hypoglycaemia

• Hypothermia

• Hyperbilirumenaemia
              High risk neonate

• Hypovolaemia

• Heavy sedation

• Infection
             Receiving hospital

• Ensure receiving hospital is aware of patients
  condition.
• Receiving Doctors name.
                 SUMMARY

• What is a neonate?
• Highlight the logistics required for safe
  transportation of the neonate.
• The checks done preparing for transportation.
• Which type of illnesses are commonly
  transferred
  (high risk)
  The receiving hospital
Questions

   End

				
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posted:12/1/2009
language:English
pages:22