Neonatal and Pediatric Transport

Neonatal and Pediatric Transport is a complicated and delicate process for clinicians. This short book is intended to help give an overview of critical care transport for the pediatric and neonatal patient.

Core Knowledge

Professional Issues

Federal regulations regarding transport

EMATALA

EMTALA is the Federal Emergency Medical Treatment and Labor Act, also known as COBRA. EMTALA is a statute which governs when and how a patient must be:

1. examined and offered treatment or
2. transferred from one hospital to another when he is in an unstable medical condition.

EMTALA applies only to "participating hospitals" under Medicare i.e., to hospitals which have entered into "provider agreements" under which they will accept payment from the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) under the Medicare program for services provided to beneficiaries of that program. In practical terms, this means that it applies to virtually all hospitals in the U.S., with the exception of the Shriners' Hospital for Crippled Children and many military hospitals. Its provisions apply to all patients, and not just to Medicare patients.

When is a patient considered stabalized?

1. (for emergency medical conditions) that no material deterioration of the patient's condition is likely to result from the transfer or is likely to occur during the transfer;
2. (for patients in active labor) the infant and the placenta have been delivered.

Transport-related Clinical Management and Skills

Physiologic impacts

Laws of science

Dalton's Law

The partial pressure of an ideal gas in a mixture is equal to the pressure it would exert if it occupied the same volume alone at the same temperature. This is because ideal gas molecules are so far apart that they don't interfere with each other at all. Actual real-world gases come very close to this ideal.

A consequence of this is that the total pressure of a mixture of ideal gases is equal to the sum of the partial pressures of the individual gases in the mixture as stated by Dalton's law. For example, given an ideal gas mixture of nitrogen (N₂), hydrogen (H₂) and ammonia (NH₃):

$P=P_{{\mathrm{N}}_2}+P_{{\mathrm{H}}_2}+P_{{\mathrm{N}\mathrm{H}}_3}$

where:
$P$	= total pressure of the gas mixture
$P_{{\mathrm{N}}_2}$	= partial pressure of nitrogen (N2)
$P_{{\mathrm{H}}_2}$	= partial pressure of hydrogen (H2)
$P_{{\mathrm{N}\mathrm{H}}_3}$	= partial pressure of ammonia (NH3)

Neonatal

Cardiovascular

Congenital heart conditions

Shock States

1. Anaphylactic
2. Cardiogenic
3. Distributive (septic)
4. Hypovolemic

Congestive heart failure

Supraventricular tachycardia (SVT)

11.03

Gastrointestinal

Necrotizing enterocolitis

11.04

Metabolic

Altered electrolyte balance

11.05

CNS/Neurological

Increased intracranial hemorrhage

11.06

Surgical Emergencies

Tracheoesophageal fistula

11.07

Special Situations

-Care of the Extremely Low Birthweight (ELBW) patient in transport