Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-18T17:10:40.857Z Has data issue: false hasContentIssue false
  • English
  • Français

Field Expedient Vasopressors During Aeromedical Evacuation: A Case Series from the Puerto Rico Disaster Response

Published online by Cambridge University Press:  09 November 2018

Jason M. Hardwick ,
Sean D. Murnan ,
Daphne P. Morrison-Ponce  and
John J. Devlin
Jason M. Hardwick*
Affiliation:
Department of Emergency Medicine, Navy Medical Center Portsmouth, Portsmouth, VirginiaUSA
Sean D. Murnan
Affiliation:
Department of Emergency Medicine, Navy Medical Center Portsmouth, Portsmouth, VirginiaUSA
Daphne P. Morrison-Ponce
Affiliation:
Department of Emergency Medicine, Navy Medical Center Portsmouth, Portsmouth, VirginiaUSA
John J. Devlin
Affiliation:
Department of Emergency Medicine, Navy Medical Center Portsmouth, Portsmouth, VirginiaUSA
*
Correspondence: Jason Mitchell Hardwick, DO 4350 Heron Pt. Portsmouth, Virginia 23703 USA E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Emergency 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 Report

Two 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.

Discussion

The 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.

Keywords

aeromedical evacuationdisaster responseHurricane Mariapre-induction push dose vasopressorsPuerto Rico
Type
Case Report
Information
Prehospital and Disaster Medicine , Volume 33 , Issue 6 , December 2018 , pp. 668 - 672
Copyright
© World Association for Disaster and Emergency Medicine 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Conflicts of interest: none

References

1. Selde, W. Push Dose Epinephrine as a Temporizing Measure for Drugs Causing Hypotension. Journal of Emergency Medical Services. http://www.jems.com/articles/print/volume-39/issue-9/features/push-dose-epinephrine-temporizing-measure-0.html. Published September 15, 2014. Accessed October 15, 2017.Google Scholar
2. Weingart, S. Push-dose pressors for immediate blood pressure control. Clin Exp Emerg Med. 2015;2(2):131-132.Google Scholar
3. Resnick, B, Eliza, B. What every American needs to know about Puerto Rico’s hurricane disaster. Vox. September 29, 2017. https://www.vox.com/science-and-health/2017/9/26/16365994/hurricane-maria-2017-puerto-rico-san-juan-humanitarian-disaster-electricty-fuel-flights-facts. Accessed October 1, 2017.Google Scholar
4. Holden, D, Ramich, J, Timm, E, et al. Safety considerations and guideline-based safe use recommendations for “bolus-dose” vasopressors in the emergency department. Ann Emerg Med. 2018;71(1):83-92.Google Scholar
5. Cole, J. Bolus-dose vasopressors in the emergency department: first, do no harm; second, more evidence is needed. Ann Emerg Med. 2018;71(1):93-95.Google Scholar
6. Acquisito, NM, Bodkin, RP, Johnstone, C. Medication errors with push dose pressors in the emergency department and intensive care units. Am J Emerg Med. 2017;35(12):1964-1965.Google Scholar
7. Kim, WY, Kwak, MK, Ko, BS, et al. Factors associated with the occurrence of cardiac arrest after emergency tracheal intubation in the emergency department. PLOS ONE. 2014;9(11):e112779.Google Scholar
8. Hefner, AC, Swords, D, Kline, JA, et al. The frequency and significance of postintubation hypotension during emergency airway management. J Crit Care. 2012;27(4):417. e9-13.Google Scholar
9. Brunauer, A, Koköfer, A, Bataar, O, et al. The arterial blood pressure associated with terminal cardiovascular collapse in critically ill patients: a retrospective cohort study. Crit Care. 2014;18(719):1-8.Google Scholar
10. Knaus, WA, Draper, EA, Wagner, DP, et al. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818-829.Google Scholar
11. Cardenas-Garcia, J, Schaub, KF, Belchikov, YG, et al. Safety of peripheral intravenous administration of vasoactive medication. J Hosp Med. 2015;10(9):581-585.Google Scholar