ATLS Module 13 - Transfer to Definitive
Care
A 50 yo female in MVC is brought to hospital with general surgical but no neurosurgical
capability. It was reported there was significant damage to the driver's side of the car with a
significantly starred windshield. GCS of 8, decreased breath sounds on left and abdominal
tenderness. On fast, she clearly has fluid in the peritoneum. What are the priorities prior to
sending it to a facility with neurosurgical capabilities? - ANS-endotracheal tube, chest tube,
and exploratory laparotomy
*pt is unstable... with hypotensive pt and + FAST, an exploratory laparotomy is mandatory to
control bleeding and correct hypotension as this will worsen neurologic outcome if not
corrected
\50 yo male brought to a facility which is a small hospital without surgical services. He was
involved in MVC in which his car sustained significant front end damage. The pt was not
wearing a seatbelt and complained of abdominal pain. He has a GCS of 13. What are the
most radiographic studies the pt should receive before transfer? - ANS-chest x ray, pelvic x
ray, FAST exam
\evidence supports that trauma outcome is enhanced if critically injured pts are treated in
trauma centers - ANS-red text
\how do you prevent inadequate handover between tx and transferring teams? - ANS--use
transfer checklist to ensure all key aspect of care are properly communicated
-verify copies of medical records and x rays are prepared and provided to transfer team
\how is patient outcome related to timeliness of transfer? - ANS-patient outcome is directly
related to time elapsed between injury and properly delivered definitive care
red text
\if resources are available and necessary procedures can be performed expeditiously, life
threatening injuries should be treated before patient transport. this may require operative
intervention to ensure the patient is in the best possible condition for transfer.
intervention before requires judgement - ANS-red text
\what are the responsibilites of referring physician in a patient transfer situation? - ANS-1.
initiate transfer during resuscitation
2. consult w receiving doctor
3. maintain familiarity w transporting agencies
4. select appropriate transport mode
5. determine level of care required during transfer
6. stabilize pt's condition before transfer
7. provide pt summary
8. ensure adequately trained personnel accompany pt
9. ensure pediatric pts are transferred to facilities with special expertise when available
\what factors determine mode of transportation? - ANS-distance, weather, availability, ability
to manage intubated pt
\what form of transfer is superior? - ANS-no one mode is superior to others
Care
A 50 yo female in MVC is brought to hospital with general surgical but no neurosurgical
capability. It was reported there was significant damage to the driver's side of the car with a
significantly starred windshield. GCS of 8, decreased breath sounds on left and abdominal
tenderness. On fast, she clearly has fluid in the peritoneum. What are the priorities prior to
sending it to a facility with neurosurgical capabilities? - ANS-endotracheal tube, chest tube,
and exploratory laparotomy
*pt is unstable... with hypotensive pt and + FAST, an exploratory laparotomy is mandatory to
control bleeding and correct hypotension as this will worsen neurologic outcome if not
corrected
\50 yo male brought to a facility which is a small hospital without surgical services. He was
involved in MVC in which his car sustained significant front end damage. The pt was not
wearing a seatbelt and complained of abdominal pain. He has a GCS of 13. What are the
most radiographic studies the pt should receive before transfer? - ANS-chest x ray, pelvic x
ray, FAST exam
\evidence supports that trauma outcome is enhanced if critically injured pts are treated in
trauma centers - ANS-red text
\how do you prevent inadequate handover between tx and transferring teams? - ANS--use
transfer checklist to ensure all key aspect of care are properly communicated
-verify copies of medical records and x rays are prepared and provided to transfer team
\how is patient outcome related to timeliness of transfer? - ANS-patient outcome is directly
related to time elapsed between injury and properly delivered definitive care
red text
\if resources are available and necessary procedures can be performed expeditiously, life
threatening injuries should be treated before patient transport. this may require operative
intervention to ensure the patient is in the best possible condition for transfer.
intervention before requires judgement - ANS-red text
\what are the responsibilites of referring physician in a patient transfer situation? - ANS-1.
initiate transfer during resuscitation
2. consult w receiving doctor
3. maintain familiarity w transporting agencies
4. select appropriate transport mode
5. determine level of care required during transfer
6. stabilize pt's condition before transfer
7. provide pt summary
8. ensure adequately trained personnel accompany pt
9. ensure pediatric pts are transferred to facilities with special expertise when available
\what factors determine mode of transportation? - ANS-distance, weather, availability, ability
to manage intubated pt
\what form of transfer is superior? - ANS-no one mode is superior to others
