A Flying Kiwi!

I recently had my first helicopter transfer of a patient. Young pt in 20’s.

Presented at 2330 with hemetemesis and PR malena, initial Hb 105. Ur 9.3 Bp 105/80 PMHx of previous bleeds and duodenumitis on scope 3-4 months ago. admitted to the ward with IVF, omeprazole.

At 0300 the patient was up to commode and passed <1L of malena and “Flaked out”

BP 80/50 P 135. pale Hb 85

Transfused 2 units and Fluid resus with target BP 100 sys.

Taken to theatre in morning 0800, Scope found large clot in 2nd part of duodenum but no fresh bleeding.

Discussed with referral centre who felt was reasonable to transfer as unable to perform emoblisation if “rescue” required after clipping.

Pt holding BP 102/60 HR 100ish.

Pt was for Helicopter Transfer (fixed wing busy) and had blood running but was felt likely to require further en route.

In NZ paramedics cannot initiate further bags of blood if required (stupid system) so they required a doctor to take patient.

So it fell to me to go. I have done ATLS but no prehospital medicine courses but do like the PHARM podcasts and felt more or less comfortable with doing it.

So was happy with few things, A,B wise was stable at that time, had backup options but god would not have wanted to use them. C had good access as had two large bore cannulae placed. Collected 2 more units of blood as a good boy scout felt be prepared is a good way to be. Lots of fluids.

Its load into ambulance and then to the helicopter and loading up. Its a small place and doing anything is a bit fiddly. Safety brief from the pilot “dont walk into any rapidly spinning blades, it makes a big mess and I hate paperwork”

After the shuffle we were off!

Weather was pretty bad but the pilots here are guns and know all the passes ect, still felt nervous flying at 200ft over the ridges/saddles.

The Pilot put it well, “helicopter, mountains, beautiful. but I like them separately not together”

<—-Nasty weather shot

Patient had a good going fluid requirement and I was convinced he was still bleeding throughout the transfer. I was playing with pressure bags a bit as we dont use them much in hospital with rapid transfusers and pumps.

Over the course of the transfer, 80 minutes patient received 2 units of blood and 3 litres of saline. but was more tachy on arrival P 120 and BP 95/55 and taken straight to theatre where bleeding ulcer was clipped. Patient did not require embolisation but had further 2 units as arrival Hb was 78.

On review, I felt it went pretty well. I have a massive amount of respect for people who do this regularly. The pilots are really amazing, flying over mountain passes with low visibility was frankly scary. From a more medical point of view little stuff makes a big difference. Its an old rule of PHARM stuff but know your kit, playing with pressure bags ect was frustrating when it should have been simple. Helicopters are a very small you forget how often you move around to do procedures ect.

So to ask anyone whos reading, have you done transfers, lots? a few? do you remember your first?

 

And finally some scenery shots for you all: