Treat patients in transport
Point-of-care testing can be used to assess patient status in flight, allowing the crew to intervene immediately. "Our goal is to try and treat the patient before we arrive at the ED [emergency deparrtment] , to get them there in the best shape we can," says Diana Herr, RN, a Mayo One flight nurse at the Mayo Medical Center in Rochester, Minnesota. Point-of-care testing is used on approximately 50% of patients transported, she reports.
It enables flight nurses to give more accurate care. "For example, our protocol says to start giving 2 liters of ringer’s lactate, and then start to give blood," says Herr. "But if we know a patient has a hemoglobin level of 5, we can go directly to treating that patient and give blood right away, since we do carry blood in the helicopter."
A baseline is established, which can be compared with tests done in the ED. "If another lab is done, and the hemoglobin was 10 and is now 8, we know the patient is bleeding faster," says Herr.
The point of care testing has saved patient’s lives, Herr reports. "When you are dealing with the golden hour for trauma, we may have only 15 minutes left. Patients may have a ruptured aneurysm, or are in the process of rupturing, or be involved in a motor vehicle accident and have a liver laceration," she notes. "Even with a simple asthma patient, the lab values may help us decide whether a patient needs to be intubated."
The ED staff is forewarned about the patient’s condition. "We often call report with the results of blood gases over the air, which gives the doctors an idea of how fast they have to work," says Herr. "If hemoglobin is low, another test can be done in the ED when the patient arrives to get a comparative set of labs to see how things have changed."
One patient who was in a car accident and had a pelvic fracture was receiving blood in route. "The initial hemoglobin was found to be 8, and over a half hour it was the same," says Herr. "This helped us to determine loss of blood and realize that we needed to increase the infusion of blood, so patient care was improved."
Sometimes the crew’s i-STAT device is used in the ED. "Many times, small hospitals around here don’t have lab facilities for a fast response, so we can get a lab in their ED for the patient," says Herr.
Accuracy is ensured. "If we do an i-STAT and it shows a hematocrit greater than 6, and it just doesn’t fit, we have to repeat it so we are not just treating on one erroneous result," says Herr. "If it still doesn’t fit, we get on the phone with the medical consultant and rule out other possibilities. We also check every patient that has an i-STAT done to make sure the next lab done correlates somewhat. For example, if we treat the patient aggressively, the hemoglobin should be better."