CASE 35
Incident
Clinical information:
• P 100.
• BP 105/60 mmHg.
• RR 20.
• GCS 15.
• SaO2 92% on air.
Blood analysis:
• PH 7.31.
• Potassium 5.9 mmol/L.
• Urea 35 mmol/L.
• Creatinine 1340 μmol/L.
• Hb 9 g/dL.
Relevant information
▪ Aircraft: Fixed wing
▪ Local resources: Local general practitioner. One land ambulance
▪ Retrieval options: Tertiary centre two hours by air
▪ Other: Time 22:00 hours
Questions
35.1 Is the patient currently safe to fly? If so, how would you package him for transport?
Midway through the flight, the patient vomits approximately 700 mL of fresh red blood into his oxygen mask.
Current clinical information:
• P 130.
• BP 85/45 mmHg.
• RR 26.
• GCS 9 (E2, V3, M4).
35.2 Discuss your management of this in-flight emergency?
The patient is now intubated and ventilated. Ten minutes post intubation, the patient suddenly becomes hypotensive (SBP 60 mmHg). The ventilator is flashing a visual alarm (see over the page).
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Discussion
35.1 The patient is a high-risk transfer but the PHR team need to consider that few other options are available. The patient needs dialysis, which he cannot get at his current location. The patient is only going to get worse without dialysis and therefore delaying the transfer will not solve the problem. Road transfer is essentially ruled out as the flight time is 2 hours and, if transferred by road, the small regional area will likely be left without local land ambulance capacity for many hours.
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