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http://projects.csail.mit.edu/courseware/?term=the-example-essay the example essay Transport. After initial stabilization, the neonate with suspected congenital heart disease often needs to be transferred to an institution that provides subspecialty care in pediatric cardiology and cardiac surgery. A successful transport actually involves two transitions of care for the neonate. (i) from the referring hospital staff to the transport team, and (ii) from the transport team staff to the accepting hospital staff. The need for accurate, detailed, and complete communication of information between all these teams cannot be overemphasized. If possible, the pediatric cardiologist who will be caring for the patient should be included in the discussions of care while the neonate is still at the referring hospital. Reliable vascular access should be secured for the neonate receiving continuous infusions of pge1 or inotropic agents. Umbilical lines placed for resuscitation and stabilization should be left in place for transport. The neonate with congenital heart disease may potentially require cardiac catheterization through this route. Particular attention should be paid to the patient's airway and respiratory effort before transport. In general, all neonates receiving a pge1 infusion should be intubated for transport (see iv.B.2.). Neonates with probable or definite congenital heart disease will most likely require surgical or interventional catheterization management during the hospitalization. Therefore, it is likely that they will be intubated at some point. Because there is real risk in not intubating these infants, as a general rule, all should be intubated for transport unless there is a compelling reason not to do so. All intubated patients should have gastric decompression by nasogastric or orogastric tube. Acid-base status and oxygen delivery should be checked with an arterial blood gas before transport. Although most noncardiac patients are transported receiving supplemental oxygen at or near 100%, this is often not the inspired oxygen concentration of choice for the neonate with congenital heart disease (see v for details oflesion-specific care). This management decision for transport is particularly important for those infants with duct-dependent systemic blood how and complete intracardiac mixing with single ventricle physiology, and emphasizes the need to consult with a pediatric cardiologist before transport to achieve optimal intratransport patient care. Finally, it is important to remember that in neonates, hypotension is a late finding in shock. Therefore, other signs of incipient decompensation, such as persistent tachycardia and poor tissue perfusion, are important to note and treat before transport.

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