Hardwick Jason M, Murnan Sean D, Morrison-Ponce Daphne P, Devlin John J
Department of Emergency Medicine,Navy Medical Center Portsmouth,Portsmouth,VirginiaUSA.
Prehosp Disaster Med. 2018 Dec;33(6):668-672. doi: 10.1017/S1049023X18000973. Epub 2018 Nov 9.
IntroductionEmergency physicians are using bolus-dose vasopressors to temporize hypotensive patients until more definitive blood pressure support can be established. Despite a paucity of clinical outcome data, emergency department applications are expanding into the prehospital setting. This series presents two cases of field expedient vasopressor use by emergency medicine providers for preflight stabilization during aeromedical evacuation to a hospital ship as part of the United States Navy disaster response in Puerto Rico. A critical approach and review of the literature are discussed.Case ReportTwo critically ill patients were managed in an austere environment as a result of the devastation from Hurricane Maria (Yabucoa, Puerto Rico; 2017). They both exhibited signs of respiratory distress, hemodynamic instability, and distributive shock requiring definitive airway management and hemodynamic support prior to aeromedical evacuation.DiscussionThe novel use of field expedient vasopressors prior to induction for rapid sequence intubation was successfully and safely employed in both cases. Both patients had multiple risk factors for peri-induction cardiac arrest given their presenting hemodynamics. Despite their illness severity, both patients were induced, transported, and ultimately admitted to the intensive care unit (ICU) in stable condition following administration of the field expedient vasopressors.Conclusion:Field expedient vasopressors were safely and effectively employed in an austere field environment during a disaster response. This case series contributes to the growing body of literature of safe bolus-dose vasopressor use by emergency physicians to temporize hypotensive patients in resource-constrained situations. HardwickJM, MurnanSD, Morrison-PonceDP, DevlinJJ. Field expedient vasopressors during aeromedical evacuation: a case series from the Puerto Rico disaster response. Prehosp Disaster Med. 2018;33(6):668-672.
引言
急诊医生正在使用大剂量血管加压药来暂时稳定低血压患者的病情，直到能够建立更确切的血压支持措施。尽管临床结局数据匮乏，但急诊科的应用正在扩展到院前环境。本系列介绍了两例急诊医学人员在航空医疗后送至医院船的过程中，为进行飞行前稳定处理而在现场临时使用血管加压药的案例，这是美国海军在波多黎各灾难应对行动的一部分。本文讨论了一种关键方法并对文献进行了综述。
病例报告
由于玛丽亚飓风（2017年，波多黎各亚布科阿）造成的破坏，两名重症患者在艰苦环境中接受治疗。他们均表现出呼吸窘迫、血流动力学不稳定和分布性休克的症状，在航空医疗后送之前需要进行确定性气道管理和血流动力学支持。
讨论
在这两例病例中，诱导快速顺序插管前现场临时使用血管加压药的新方法均成功且安全地得到应用。鉴于患者当前的血流动力学状况，两人在诱导期发生心脏骤停均有多种危险因素。尽管病情严重，但在使用现场临时血管加压药后，两名患者均顺利诱导、转运，并最终以稳定状态入住重症监护病房（ICU）。
在灾难应对期间，现场临时血管加压药在艰苦的现场环境中得到了安全有效的应用。本病例系列为急诊医生在资源受限情况下使用大剂量血管加压药来暂时稳定低血压患者病情的文献不断增多做出了贡献。
哈德威克JM、默南SD、莫里森 - 庞塞DP、德夫林JJ。航空医疗后送期间的现场临时血管加压药：波多黎各灾难应对的病例系列。院前灾难医学。2018；33(6):668 - 672。
