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Question: EMS

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You are seeing a critically ill 4 week old with bilious vomiting, abdominal distension, and shock. You have a high suspicion for volvulus. You have resuscitated the infant and improved hemodynamic stability but you are at an ED with no pediatric surgeon available and no PICU. The nearest children’s hospital with these capabilities is 100 miles away. There is a light rain but the road conditions are good and there is no traffic. 

Which of the following is the best option?

pemsou5_wp • August 23, 2022

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  1. Kelly August 23, 2022 - 1:26 pm Reply

    B) Helicopter transport to the children’s hospital
    The baby should be transferred for higher level of care. The pediatric surgeon is unlikely to have privileges at your hospital, and after surgery there would be no PICU. The general surgeon would not likely have the expertise or experience to operate on a small infant with volvulus. Air transport is preferred over ground when there are both time-sensitive interventions needed and long ground transport times. Helicopter is generally used for distances < 150 miles, and there will be the advantage that the children’s hospital will likely have a landing pad, whereas a fixed wing aircraft will require a runway to land. Helicopters are limited in severe weather conditions, but should be able to operate in a light rain.

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