Critical care transport of patients who have acute neurological emergencies.
This article reviews the special questions and issues in critical care transport related specifically to the care of patients who have neurologic emergencies. It first considers potential indications for transport and reviews attempts to create a hierarchical stroke center system akin to that developed for trauma care. It then discusses therapeutic concerns relating to the transport environment and the use of specific interventions, including the effects of end-tidal CO(2) monitoring on intracranial pressure, patient outcomes after traumatic brain injury, and opportunities to initiate therapeutic hypothermia in comatose survivors of cardiac arrest during transport. Finally, the cost of critical care transport of patients who have neurologic emergencies is considered.
Uren
Bradley
B
Department of Emergency Medicine and Survival Flight, University of Michigan, Ann Arbor, MI, USA. bguren@umich.edu
Lowell
Mark J
MJ
Silbergleit
Robert
R
D001930:Brain Injuries / Q000628:therapy*; D002245:Carbon Dioxide / Q000032:analysis; D003128:Coma / Q000628:therapy; D003422:Critical Care; D004630:Emergencies; D004632:Emergency Medical Services; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007036:Hypothermia, Induced; D008991:Monitoring, Physiologic; D020521:Stroke / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014187:Transportation of Patients / Q000191:economics
D005343:Fibrinolytic Agents; D002245:Carbon Dioxide; D010959:Tissue Plasminogen Activator