A standardized treatment protocol for blood pressure management in transport patients with a reported diagnosis of acute aortic dissection or symptomatic aortic aneurysm

Abstract

Reprint no. 74/l/21 0 The use of standardized treatment protocols (SIR) are a common practice in the air medical industry. These proto cols provide nonphysician flight crews with specific guidelines on the medical management of the patients they transport. Although implementation of protocols is widely accepted, evaluating their application and reporting their effectiveness is relatively rare. On June 12, 1995, Stanford Health Services (SHS) Life Flight/Medical Transport programs instituted a compre hensive set of STPs designed to provide medical guidelines for the RN/RN crew that transported patients. One of the more aggressive protocols addressed the blood pressure (BP) management of pa tients with a reported diagnosis of acute aortic dissection or symptomatic aortic aneurysm. Initially, a quality assurance evaluation was performed to ascertain how effective the crews were in applying the protocol. To determine whether ap plication of the protocol had a significant effect on BP outcomes, a second analysis was performed to compare BP manage ment provided by SHS transporting crews versus nonSHS crews that brought inter-facility transfers to SHS. Emergent medical management in aortic dissections focuses on minimizing the aortic forces that can exacerbate the dissection. For symptomatic aneurysms, management is aimed at decreasing aortic wall tension to prevent rupture. Both goals can be achieved through pharmacologic intervention using a fast-acting