Monitoring and Prevention of complications During the Transfer of Polytrauma Patients

Velammal

Senior Staff Nurse, Kauvery Hospital, Tennur, Trichy, Tamil Nadu

Introduction

The transfer of polytrauma patients’ individuals with multiple traumatic injuries requires meticulous planning and execution to prevent complications and ensure patient safety. Here’s an outline covering monitoring and prevention of complications during transfer.

1.Pre-Transfer Preparation

  • Comprehensive Assessment: Ensure full assessment of the patient’s injuries, including airway, breathing, circulation, disability (neurologic status), and exposure (trauma survey).
  • Stabilization: Address life-threatening conditions before transfer (e.g., hemorrhage control, airway management, chest tube insertion).
  • Documentation: clear communication and transfer documentation (vital signs, interventions, imaging, labs).

Equipment and Staffing

Trained Personnel

At minimum, an advanced life support (ALS)-trained provider; ideally, a trauma-trained physician or critical care specialist.

Essential Equipment

Portable ventilator, defibrillator, infusion pumps, suction.

Backup oxygen supply, medications (sedatives, vasopressors), blood and blood products.

Immobilization tools (cervical collar, splints, spine board).

2. Monitoring During Transfer

Vitals Signs Monitoring:

  • Continuous ECG, pulse oximetry, non-invasive blood pressure, and capnography (in intubated).
  • Temperature monitoring to prevent hypothermia

Neurological Monitoring

  • Glasgow Coma Scale (GCS) assessment, pupil size and reactivity.

Hemodynamic Monitoring

  • Urine output (via Foley catheter).
  • Blood loss estimation and fluid balance.

3. Prevention of Common Complications

  • Airway Compromise
  • Hemodynamic Instability
  • Hypoxia/Hypoventilation
  • Hypothermia
  • Secondary Brain Injury
  • Reassessment

4. Communication and Coordination

Pre-arrival Notification: Inform the receiving facility of estimated arrival time, patient condition, and needed interventions.

Handover: Structures handoff (e.g., SBAR format) upon arrival.

Immediate Post-Transfer Assessment

Primary Survey Reassessment(ABCs):

  • Airway: Check patency, tube placement (in intubated), suction as needed and oral airway.
  • Breathing: Respiratory rate, oxygen saturation, chest expansion, auscultation.
  • Circulation: Check pulse, blood pressure, signs of bleeding, perfusion.
  • Disability: Reassess Glasgow Coma Scale, pupils.
  • Exposure: Look for missed injuries, maintain normothermia

Immediate Post-Transfer Assessment

Repeat vital signs and Monitoring:

  • Continuous ECG, pulse oximetry, blood pressure, waveform capnography
  • Urine output (renal perfusion), temperature monitoring.

Comprehensive Secondary Survey

Head-to-toe re-evaluation: Look for overlooked injuries (e.g., fractures, soft tissue damage).

Repeat Imaging and Labs: CT Scans, X-rays, FAST ultrasound, blood tests (ABG, CBC, coagulation, lactate).

While doing a CT/MRI

  • Primary Stabilization
  • Multidisciplinary Team Involvement
  • Prepare for Transfer
  • During Transfer
  • At the CT Room

Primary Stabilization(ABCs)

  • Ensure the airway is patient (may require intubation)
  • Ensure breathing is adequate (O2, Chest tubes if needed)
  • Manage circulation (IC Access, fluids, blood transfusions if required)
  • Control any major external bleeding

Immobilize the spine (especially cervical spine with a collar and backboard)

Multidisciplinary Team involvement

  • Trauma surgeon/ER Doctors
  • Radiologist
  • ICU/ER Nurse
  • Radiology Technician
  • Anesthesiologist (if intubated or unstable)

Prepare for Transfer

  • Portable monitor (Spo2, ECG, BP)
  • Ensure oxygen source is portable and functional.
  • IV access secures and meds carried along
  • Suction ready if patient is intubated
  • Backboard or scoop stretcher with head blocks and straps.
  • Portable ventilator, if needed.

Illustrative Image

Communication

Maintain a proper communication with the patient (if conscious) and family.

During Transfer

  • At least 3 trained personnel accompany the patient.
  • Maintain spinal precautions at all times.
  • Monitor vitals continuously.
  • Be ready to handle cardiac arrest or sudden deterioration.

At the CT Room

  • Communicate with the CT techs about the paient’s condition.
  • Transfer gently from stretcher to CT table while maintaining spinal alignment.
  • Continue monitoring and support during the scan.
  • Prefer whole-body trauma protocol CT (head, neck, abdomen, chest, pelvis).

After CT/MRI

  • Safe Transfer Back to ER:
  • Maintain full spinal precautions
  • Continue vital sign monitoring
  • Ensure oxygen, ventilator, and IV lines are intact
  • Team coordination: At least 3 trained staff during transfer.

Decide to Next Step

Emergency Surgery: For internal bleeding, perforated organs.

ICU admission: For ventilation, monitoring.

Angioembolization: For pelvic or solid organ bleeding.

Kauvery Hospital