Notes from the Co-Editor
Steve Sittig, RRT-NPS, C-NPT, FAARC
As I draft this edition of my “Notes” column, the month of July is nearly half over. It always seems once the 4th of July has passed the summer we all wait for only accelerates to fall. I hope you have had a chance to take a relaxing summer vacation. I was lucky enough to get away for a short period of time to go fishing with my brother in South Dakota. It was so relaxing to be on the water with no pagers or VOIP phones.
In this issue we have a short description of some of the pertinent transport-related lectures to be presented at AARC Congress 2014 in Las Vegas, Dec. 9-12. There are a great number of other lectures relevant to neo/peds transport in addition to the ones listed in this issue. I urge you to take a look at the program in its entirety, as the Program Committee has once again outdone itself.
Also during the Congress we will recognize our 2014 Transport Specialty Practitioner of the Year. I am not sure how many submissions were received this year but am betting another deserving transport professional will be honored. As I have said before, as a past recipient I know that this is great career recognition for those who go above and beyond every day.
I hope to see you in Vegas in December. In the meantime, may all your transports end safely for you and your patients.
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AARC Congress 2014: Lots to Offer the Transport RT
Steve Sittig, RRT-NPS, C-NPT, FAARC
This year’s AARC Congress in Las Vegas, Dec. 9-12 at the Mandalay Bay, promises to be an extraordinary event for all respiratory therapists. All the specialty sections submitted topics for consideration and the Transport Section was no exception. This year we have some outstanding topics, and looking through the entire program, I know it will be a busy four days of lectures, not to forget the Exhibit Hall.
Here’s a look at just some of the sessions that I think will be of special interest to those of us practicing in the transport environment —
Thursday, December 11
9:50-10:20 a.m.
Surface & Air Transport Section Membership Meeting
Billy L. Hutchison, RRT-NPS, Presiding
Section members meet to determine their needs and priorities, as well as how to use AARC resources to accomplish them. All Congress attendees, including section non-members, are invited to attend and to participate
Symposium: Uncommon Etiologies of Neonatal/Pediatric Respiratory Distress: A Transport Case Series
10:30-11:05 a.m.
Neonatal Respiratory Distress and Irritability: Neonatal Absence Syndrome (NAS) of a Different Etiology?
Bradley A. Kuch, RRT-NPS, FAARC, Pittsburgh, PA
Content Category: Neonatal/Pediatric
Neonatal absence syndrome (NAS) continues to be a major reason for neonatal referral to tertiary care centers. A large majority of these referrals are a result of narcotic withdrawal; however withdrawal from non-narcotic pharmacologic agents can result in a similar presentation. Selective Serotonin Reuptake Inhibitors (SSRI) are one such agent. The lecture will begin with a case-review of a neonate referred for respiratory distress and irritability of unknown etiology. Epidemiology, symptomatology, treatment, and outcome of neonatal SSRI withdrawal will be discussed. The lecture will conclude with a literature review of SSRI withdrawal in the neonatal patient.
11:10-11:45 a.m.
Not All Cardiogenic Shock Comes From the Heart!
Steven E. Sittig, RRT-NPS, FAARC, Rochester, MN
Content Category: Transport, Neonatal-Pediatrics
This case study will discuss the presentation of a 3-day-old term infant arriving at a local emergency department with severe respiratory distress. Attendees will be lead through a systematic differential approach the pediatric transport team completed to stabilize this child. Ultimately the audience will learn the unique condition encountered and why all causes of respiratory distress may not be so evident. Discussion will then focus on pathology and treatment of this case of high cardiac output failure.
11:50 a.m.-12:25 p.m.
The 3 Most Interesting Neonatal/Pediatric Transport Cases I’ve Ever Seen
Steven E. Sittig, RRT-NPS, FAARC
Content Category: Transport, Neonatal-Pediatrics
The specialty area of medical transport can be very dynamic as well as challenging. All transport RTs have stories to tell of their experiences and how even the best laid plans can throw you a twist to your day — not unlike Forrest Gump’s “Life is like a box of chocolates . . . you never know what you are going to get.” This lecture will focus on the speaker’s most interesting transport cases in his career so far.
Symposium: Specialty Care Transport: 2014 and Beyond
1:45-2:20 p.m.
The Survey Says . . .: Results of a National Survey of Specialty Care Transport Teams
Alex J. Brendel, MBA, RRT-NPS, Roanoke, VA
Tabatha M. Dragonberry, RRT-NPS, AE-C, Washington, DC
Content Category: Clinical Practice
In 2014, two respiratory care practitioners surveyed specialty care transport teams across the country to find out how RCPs are being utilized. The survey included questions on: team composition, scope of practice, licensure requirements, educational requirements, competencies, and many other items. This presentation will review the results of the survey and discuss strategies for increasing the presence of RCPs on specialty care teams.
2:25-3:00 p.m.
The Rules of the Road: What You Need to Know About Licensure & Interstate Transport
Alex J. Brendel, MBA, RRT-NPS
Content Category: Clinical Practice
There is a lot of confusion among respiratory care practitioners about whether their home state’s licensure laws cover them while on a transport to another state. This presentation will look at all of the states that currently have a reciprocity agreement or waiver in place for transport therapists and offer some strategies for approaching the states around you with a reciprocity agreement.
Symposium: Respiratory Care and the Trauma Patient
3:05-3:40 p.m.
ARDS and the Trauma Victim
Joe C. Hylton, RRT-NPS, NREMT-P, FAARC, Charlotte, NC
Content Category: Adult Critical Care
ARDS is a devastating clinical syndrome that frequently impacts trauma victims. Early recognition and treatment can significantly affect mortality, even in the transport environment. This presenter will discuss how trauma victims are uniquely susceptible to developing the syndrome. Recognition and interventions for conventional treatment of ALI/ARDS will be discussed.
3:45-4:20 p.m.
Airway Management of the Trauma Victim
Brady Scott, MS, RRT-ACCS, Chicago, IL
Content Category: Adult Critical Care
Trauma patients can present some of the most challenging airway scenarios. This presentation will cover intubation techniques in the spinal cord injury, severe facial trauma, and other out of the box situations.
4:25-5:00 p.m.
Mechanical Ventilation and TBI: How to Ventilate the Traumatic Brain Injured Patient
Carl R. Hinkson, RRT, FAARC, Seattle, WA
Content Category: Adult Critical Care
Ventilating the TBI patient can be a challenge. This presentation will cover approaches to reducing intra-cranial pressure and how the ventilator may help or hurt in the process.
3:05-3:40 p.m.
In-flight Cardiorespiratory Emergencies: Respiratory Care Above 30,000 Feet
Alex T. Rotta, MD, FAACP, FCCM, Cleveland, OH
Content Category: Neonatal-Pediatrics
Have you ever been in a position where you were called into action for an emergency on a domestic flight? This presentation equips you with the tools to handle the unexpected
4:25-5:00 p.m.
Are Your Patients Getting High? The Effects of Altitude on Our Patients and the Precautions They Need to Take
Ralph W. Stumbo, Jr., RRT, CPFT, Tacoma, WA
Content Category: Pulmonary Function
With our increasingly mobile society, patients are traveling to and living more often at locations with higher altitude. We all know there are hazards to flying but soon forget that there are many places where people live and vacation that are at similar attitudes. This presentation will discuss some of these places and what precautions are prudent for patients to take
Friday, December 12
9:00-9:35 a.m.
ECMO During Patient Transport
Bradley A. Kuch, RRT-NPS, FAARC, Pittsburgh, PA
Content Category: Adult Critical Care
ECMO is a complex procedure performed in many hospitals across the country. Taking this procedure on the road creates unique challenges for the transport team.
9:40-10:15 a.m.
Creative Equipment Solutions During Transport
Wade Scoles, RRT-NPS, NREMT, Spokane, WA
Content Category: Adult Critical Care
Have you ever been in a position where the piece of equipment you need isn’t available? Respiratory therapists pride themselves on coming up with creative solutions to solve these problems. This lecture will review some creative solutions for using equipment during transport.
10:20-10:55 a.m.
Critical Care Transport in Developing Nations: A Comparison with the U.S. HEMS System
Richard P. Mitchell, RRT-NPS, Greenville, NC
Content Category: Adult Critical Care
As of September 2013, there were 299 air medical services with 993 bases and 1,301 aircraft serving the United States. Calculations show that 69% of interstate, 63% of principal, and 54% of minor arterial miles are now within a nominal 20-minute air medical RW response. Data also show that the number of traffic fatalities in the U.S. has decreased by 15% in most states. Despite recent concerns regarding safety, studies show that the Air EMS system in the U.S. is an effective and worthwhile venture. In developing nations, geography, terrain, poor road conditions, and the centralization of definitive care make air EMS, especially RW, very attractive. Despite the costs and difficulties, the building of modern HEMS is critical. This presentation will discuss need, development, and implementation strategies of critical care transport in developing countries.
11:00-11:35 a.m.
Noninvasive Ventilation in Transport: What Could Possibly Go Wrong?
Wade Scoles, RRT-NPS, NREMT, Spokane, WA
Content Category: Adult Critical Care
The popularity of noninvasive ventilation is growing but there are limitations and challenges of providing NIV during transport. This interactive presentation will discuss techniques of providing NIV (CPAP & BiPAP) to neonatal, pediatric, and adult patients during transport. The speaker will focus on what has worked (and not worked) for his program and the challenges they still face. Participants will be encouraged to share their experiences as well.
11:40 a.m.-12:15 p.m.
Air Transport of Nitric Oxide Patients
Juan Eduardo Romero Toledo, MS, CRT, Santiago, Chile
Content Category: Adult Critical Care
The presenter will describe the air transport system, the characteristic of the patients, and the number of patients transferred.
I hope to see you in Las Vegas this December, as this is the best opportunity we’ll have all year to hear great lectures and network with therapists from across the country. And it’s a great way to earn the continuing education credits you need to maintain your license to practice as well!
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Neonatal Resuscitation Quiz
Neonatal resuscitation is a key skill for those of us on neo-peds teams. Test your knowledge via this short, four item quiz.
1. How many minutes should it take for a newborn to attain a targeted preductal saturation level of 70-75%?
a. 1 minutes
b. 3 minutes
c. 5 minutes
d. 7 minutes
2. Recent studies have shown that therapeutic hypothermia can improve neurologic outcomes in what range?
a. 31.5 to 32.5 degrees Centigrade
b. 30.5 to 31.5 degrees Centigrade
c. 33.5 to 34.5 degrees Centigrade
d. 34.5 to 35.5 degrees Centigrade
3. A newborn weighing 1500 grams and born at an estimated gestational age of 28 to 29 weeks should have what endotracheal tube size placed?
a. 2.5 mm
b. 3.0 mm
c. 3.5 mm
d. 2.0 mm
4. What pharmacologic agent administered via ETT when coming into contact with a colorimetric CO2 detector can render the detector inoperative?
a. Epinepherine
b. Narcan
c. Sodium Bicarbonate
d. Atropine
Answers
1. b
2. c
3. b
4. a
Reference: American Heart Association Neonatal Resuscitation Text Book 6th edition.
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