Helicopter transport & head injury

• Previous message: Problem with Digest mode
• Next message: Helicopter transport & head injury
• Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]

If intubation is required for optimal management of the head injury 
(maintenance of adequate oxaemia, avoidance of hypercarbia etc) then the 
intubation should preceed.

Alternatively, If there is a significant risk in the helicopter for loss of 
control of the airway then intuabtion should be done prior to flight for 
that reason too.  In general we would have a lower threshold for intubating 
if helicopter transport is being used.  In this context the presence or 
otherwise of a head injury is irrelevant - you seem to be implying that HI 
is in some way a contraindication for intubation.  The reverse is the case.

John

John L Holmes
Director Emergency Medicine
Mater Hospital, Broisbane
(temp ED locum, Galway University College Hospital, Ireland)

>From: "Black, John" <John.Black at orh.nhs.uk>
>Reply-To: Trauma & Critical Care mailing list <trauma-list at trauma.org>
>To: 'Trauma & Critical Care mailing list' <trauma-list at trauma.org>
>Subject: Helicopter transport &  head injury
>Date: Mon, 13 Oct 2003 16:59:55 +0100
>
>Colleagues,
>
>Picking up the thread of hazardous potential problems arising in flight
>(e.g. vomiting), under what circumstances would you advocate undertaking
>rapid sequence intubation prior to helicopter transport in the context of
>significant head injury, assuming that there are the resources available to
>undertake this?
>
>
>John Black
>John Radcliffe Hospital
>Oxford, UK
>
>
>
>Our copter flies 50 - 60 flights per month.  Less than 1% of patients have
>any trouble with nausea and vomiting.  We do not give the patients anything
>for airsickness.  It isn't a problem for us.  (of course, now that I have
>talked about it the next 15 patients will vomit and aspirate!)
>
>E
>
>Errington C. Thompson, MD, FACS
>Trauma Surgeon
>Trinity Mother Frances
>Tyler, Tx.
>ecthompson at msn.com <mailto:ecthompson at msn.com>
>
>Don't think you are
>Know you are
>
>                            - Morpheus (The Matrix)
>----- Original Message -----
>From: Chris + Mandy Cresswell 
><mailto:chris.mandy.cresswell at paradise.net.nz>
>
>To: Trauma  <mailto:trauma-list at trauma.org> & Critical Care mailing list
>Sent: Saturday, October 04, 2003 1:47 AM
>Subject: Re: anti-emetics after head injury
>
>Yep, we do that to.  Do use use an antiemetic?
>
>Regards
>
>Dr Chris Cresswell
>Medical Officer
>Turoa and Whakapapa Ski Fields
>Mt Ruapehu
>New Zealand
>----- Original Message -----
>From: E C Thompson <mailto:ecthompson at msn.com>
>To: Trauma  <mailto:trauma-list at trauma.org> & Critical Care mailing list
>Sent: Friday, October 03, 2003 5:34 PM
>Subject: Re: anti-emetics after head injury
>
>In a patient without facial fractures, we use an NG tube.
>
>E
>
>Errington C. Thompson, MD, FACS
>Trauma Surgeon
>Trinity Mother Frances
>Tyler, Tx.
>ecthompson at msn.com <mailto:ecthompson at msn.com>
>
>Don't think you are
>Know you are
>
>                            - Morpheus (The Matrix)
>----- Original Message -----
>From: Chris + Mandy Cresswell 
><mailto:chris.mandy.cresswell at paradise.net.nz>
>
>To: trauma-list at trauma.org <mailto:trauma-list at trauma.org>
>Sent: Thursday, October 02, 2003 4:10 AM
>Subject: anti-emetics after head injury
>
>Greetings.  What do you use (if anything) as a prophylactic antiemetic 
>after
>a head injury.  Our helicopter paramedics request antiemetics be given
>before flight.  I routinely use haloperidol as an antiemetic but the
>surgeons at one of our recieving hospitals don't like it as they think it
>may over sedate people (even though most people we use it on in antiemetic
>doses (eg 4mg for an adult have no noticable sedation, or may decrease
>seizure threshold (is this a real or just a theoretical effect).  I note
>Tintinalli [Emergency Medicine, text by American College of Physicians]
>recommends droperidol for post head injury agitation - therefore 
>haloperidol
>should be OK shouldn't it?
>Any thoughts, evidence, recommendations for cheap antiemetics or advice
>against using antiemetics at all would be much appreciated.
>Regards
>Dr Chris Cresswell
>Medical Officer
>Turoa and Whakapapa Ski Fields
>Mt Ruapehu
>New Zealand
>
>   _____
>
>--
>trauma-list : TRAUMA.ORG
>To change your settings or unsubscribe visit:
>http://www.trauma.org/traumalist.html
>
>   _____
>
>--
>trauma-list : TRAUMA.ORG
>To change your settings or unsubscribe visit:
>http://www.trauma.org/traumalist.html
>
>   _____
>
>--
>trauma-list : TRAUMA.ORG
>To change your settings or unsubscribe visit:
>http://www.trauma.org/traumalist.html
>--
>trauma-list : TRAUMA.ORG
>To change your settings or unsubscribe visit:
>http://www.trauma.org/traumalist.html

_________________________________________________________________
Get less junk mail with ninemsn Premium. Click here  
http://ninemsn.com.au/premium/landing.asp

• Previous message: Problem with Digest mode
• Next message: Helicopter transport & head injury
• Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]