Preparing patients for transport: DipIMC practice questions

Answer: E

Continuous waveform capnography

The ICS/FICM minimum standards of monitoring during transport are continuous observation, cardiac rhythm (ECG), non-invasive blood pressure, oxygen saturation, temperature and, in intubated and ventilated patients, end-tidal carbon dioxide. The guidance states that capnography is mandatory in all intubated, ventilated patients; it is the monitor that tells you in a noisy, moving vehicle that the tube has displaced or the circuit has disconnected. The other options can be useful in selected patients but none is a minimum standard. Two related points are examined. Intermittent non-invasive blood pressure is sensitive to motion artefact, unreliable in a moving vehicle and a drain on the monitor battery, so an arterial line should normally be used. All monitors, including the ventilator display and syringe drivers, should be visible to the escorting staff, and alarms should be visible as well as audible.

Answer: C

Treat the hyperkalaemia and recheck potassium before departure

The ICS/FICM pre-transfer checklist sets metabolic thresholds for departure: blood glucose above 4 mmol/l, potassium below 6 mmol/l and ionised calcium above 1 mmol/l, with acceptable acid–base balance. Here glucose and calcium are acceptable but the potassium of 6.4 mmol/l is not, so it should be treated and rechecked before the patient leaves. The guidance says adequately resuscitated and stabilised patients should not normally need significant changes to treatment during transport, and that if an emergency does arise it should not be treated in a moving ambulance — the vehicle is stopped in a safe place first. Leaving with calcium drawn up plans for an arrhythmia in transit instead of preventing it; giving bicarbonate without rechecking abandons the measurement that shows whether stabilisation has worked; and handing the problem to the receiving unit leaves it uncorrected for the whole journey. Cancelling is an over-reaction: this is a correctable abnormality in a patient who needs the transfer, so the right course is to delay long enough to correct it.