For critically ill inpatients on multiple pressors, mechanical ventilation, and/or mechanical circulatory support devices, it’s customary for the anesthesiologist to be a part of the transport team. Over the years, I’ve seen countless styles of preparation for this important task that MANY operative staff take for granted. So much can go wrong in the middle of the hallway, and if you’re not prepared, well… it’s an (inexcusable) lapse in patient safety.
While my resident is preparing the operating room, I’ll visit the patient to verify their consent and discuss my plan and concerns with the family/caretakers. I’ll go from left-to-right looking at the infusions (including doses), ventilator settings, mechanical circulatory support (MCS) device settings, monitors and access (peripheral IV, arterial line, central line, PA catheter, drains, etc.), glance at the labs over the last 24 hours, and then most importantly, have a discussion with the patient’s nurse regarding our plan.
Invariably, these transports happen right at shift change for my nursing colleagues, so I discuss what I’ll need for transport and how I can facilitate the process well in advance. I’ll bring all the necessary medications (namely sedation +/- paralytics, pressors, and flushes) and equipment (ie, extra trach tubes) to ensure that I can appropriately resuscitate the patient en route if need be. As soon as we arrive to the OR, I transition portable monitors and infusions to my operative set up and ensure that nothing gets pulled out during the entire process. This isn’t possible without the help of patient transport, nurses, and perfusionists!
Drop me a comment below with questions! 🙂
