Page 251 - 2023 SMOG Digital

verify tube pressure. A cuff pressure between 20-30cm H 2 O is recommended
to provide adequate seal and reduce the risk of complications or tissue
damage. Verify with supervising physician or flight surgeon before filling
endotracheal tube with saline. Routine filling of endotracheal tubes with saline
is no longer recommended.
• Flow Rates: Decreased atmospheric pressure may interfere with IV flow rates and/or
pump function. These must be monitored continuously.
• Invasive Blood Pressure: Adjust/re-calibrate monitor every 1000ft if required based
upon monitoring device.
• Hypothermia: As altitude increases, the temperature will drop about 3.5°F/1000ft.
This is further complicated in the H-60 due to rotor-wash, forward air speed, normal
lapse rate. Therefore, patients must be protected from hypothermia at all times. This
includes use of the Hypothermia Prevention and Management Kit (HPMK), blankets,
heaters if available, and closing cabin doors/crew windows during transport.
• Hypoxia: Patients are at increased risk of hypoxia during transport at altitude. If
transfers are taking place in high-altitude locations, pulse oxygenation should be
monitored at all times and the medic/provider should maintain a low threshold for the
use of supplemental O2. At no time should the patient’s O2 be allowed to go below
92% (commercial pulse oximeters read up to 3% off, therefore a sat of 91% may be
seen in a patient who is really at 88%.). Patients who smoke or have underlying
cardiopulmonary disease are at increased risk even at low altitudes.
• Dysbarism: Patients may experience discomfort due to gas expansion in air-filled
body spaces (e.g., ears, sinuses, teeth) during ascent. Conversely, patients and
aircrew may experience "squeeze" resulting from descent from altitude. These are
typically mild during RW transport, however, if severe, altitude should be held and
attempts made to alleviate pain and/or slow rate of ascent/descent.

Document procedure, results, and vital signs.

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