Characteristics and Demographics of Patients Requiring Emergent Air Medical.

Background: As integrated health systems become more common, interfacility patient transfers will increase and air transport programs will be prioritized. Understanding characteristics of patients triaged to air medical transport will assist with resource allocation and needs assessment. The objective of this study was to investigate the demographics and clinical characteristics of patients that presented to the emergency department (ED) and subsequently required emergent air medical interfacility transport. Methods: This was a retrospective, multicenter study conducted at eight hospitals within Northwell Health, the largest academic health system in New York state. The study was conducted between December 1, 2014, and July 31, 2020, and included patients who presented to an ED and subsequently required emergent air medical interfacility transport. Results: Overall, the median age was 37 years (IQR 4-66), and 231 (54%) subjects were males. The majority of subjects (59%) had no reported comorbidities, arrived by ambulance (52%), and were emergency severity index triage 2 (48%). Frequent indications for transfer were nontraumatic neurologic (37%), pulmonary or respiratory (13%), trauma (12%), and cardiovascular (12%). Most patients were not ventilated before transport (71%). The median time to call for transport at the sending institution was 2:42 hours (IQR 1:14-6:54), and the median length of stay was 4:12 (IQR 2:31-8:48). Most patients were subsequently admitted (96%) at the receiving institution to an intensive care unit (72%). Conclusions: This study describes patients' demographic and clinical characteristics who required emergent air medical transport. Helicopter transport is costly, and data from these patients may further help our understanding of who is transported by air and how important air transport is to the health system.

Tranexamic acid for treatment of pulmonary hemorrhage after tissue plasminogen activator administration for intubated patient.

BACKGROUND: The risk of tPA in the treatment of stroke, is that approximately 5% of patients may have significant intracranial bleeding, increasing mortality to 45%. Use of tPA can also cause other forms of life-threatening bleeding, most commonly gastrointestinal bleeding. In this case review, we discuss the presentation and management of a patient with post-tPA pulmonary hemorrhage and the use of tranexamic acid (TXA) for the cessation of bleeding. CASE REPORT: A 78-year-old female reported dysarthria, left-sided facial droop, left sided weakness of 1-hour duration with an initial NIH stroke scale (NIHSS) of 7. The patient had tPA administered, had an abrupt change in mental status and was ultimately intubated for airway protection. After endotracheal intubation, the patient began to hemorrhage from the endotracheal tube and was administered nebulized TXA totaling 2 g over the course of 20 min, with subsequent cessation of bleeding. tPA administration comes with inherent risks given the known bleeding complications and no consensus for the reversal of bleeding secondary to tPA. TXA may be a viable option in the setting of tPA induced pulmonary hemorrhage.