transfer to definitive care - info medical ya-ha · case scenario a 27-year-old ... diperiksa...
TRANSCRIPT
Case Scenario
● A 27-year-old male is brought to an 80-bed
rural hospital following an MVC.
● The hospital has a CT scanner and
ultrasound capability, but no neurosurgical
facility.
● Vitals: Systolic BP 80; shallow breathing;
and GCS score 6.
What are your concerns and priorities in
organizing transfer of this patient?
Objectives
● Identify injured patients who may
require transfer from the primary
facility to a trauma center.
● Discuss the procedures for optimal,
safe patient transfer.
Transfer Principles
● Know institutional capabilities.
● Be prepared and anticipate patient needs.
● Do no further harm.
● Identify patients whose needs exceed
local resources.
Transfer Principles
● Perform only essential procedures.
● Establish direct communication between
referring and receiving doctors.
● Transport to closest, appropriate facility.
● Use most appropriate mode of transport.
Transfer Decisions
● Patients with multiple
injuries
● Patients whose needs
exceed institutional
capabilities ● Patients with comorbidities
● Extremes of age ● Preexisting disease
Whom do I transport?
Transfer Decisions
● Transfer to an institution capable of
providing equipment and resources
● Transfer to an appropriate, qualified
physician who can: ● Make the diagnosis ● Treat the patient’s injuries ● Provide commitment and resources
Where should I send the patient?
Transfer Decisions
● Transfer after life-threatening problems are managed.
● Transfer after disabling injuries are stabilized. ● Transfer after arrangements are made. ● Transfer before performing unnecessary tests
and procedures.
When should I transport the patient?
Avoid delay!
Transfer Decisions
Determine by: ● Care required en route ● Patient destination ● Available resources ● Existing transfer
agreements
How should I transport the patient?
©ACS 11
Summary What is the problem?
Not all hospitals can care for all trauma
patients.
Who needs transfer?
Patient whose needs exceed local
resources.
Where should the patient be sent?
Ideally, to a verified trauma center.
©ACS 12
Summary
When should they be transported ?
After immediate, life-threatening injuries
are addressed.
How should the patient be transported
?
According to patient need and available
resources
Kasus 1 (Lanjutan)
C. Menantu sang dokter 35 tahun dengan
kesakitan, keluar 7 menit kemudian,
merasa nyeri di dada kanan. Setelah
diperiksa paramedis, ada jejas di anterior
linea mid axillaris kiri setentang lipatan
payudara. TD 130/90 mmHg, Nadi
96x/menit, Nafas dangkal 36x/menit
14
Kasus 1 (Lanjutan)
D. Istri sang dokter 63 tahun dikeluarkan tim
penolong 30 menit kemudian bersama
sang cucu dari danau yang dingin. TD
tidak terukur, Nadi tidak teraba, Nafas
tidak terdengar
E. Cucu sang dokter 7 tahun yang
dikeluarkan tim penolong danau, TD tidak
terukur, Nadi tidak teraba, Nafas tidak
terdengar
15