Uren Bradley, Lowell Mark J, Silbergleit Robert
Department of Emergency Medicine and Survival Flight, University of Michigan, Ann Arbor, MI, USA.
Emerg Med Clin North Am. 2009 Feb;27(1):17-26, vii. doi: 10.1016/j.emc.2008.09.001.
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.
本文回顾了重症监护转运中与神经系统急症患者护理相关的特殊问题。首先考虑转运的潜在指征，并审视建立类似于创伤护理分级系统的卒中中心分级系统的尝试。接着讨论与转运环境以及特定干预措施使用相关的治疗问题，包括呼气末二氧化碳监测对颅内压的影响、创伤性脑损伤后的患者预后，以及在转运过程中对心脏骤停昏迷幸存者启动治疗性低温的机会。最后，考量神经系统急症患者的重症监护转运成本。
