Patients with a TBI requiring hyperosmolar therapy will most likely require neurosurgical specialists and transfer to either the ICU or the operating room for urgent neurosurgical intervention. Transfer from community hospitals should be performed in the most expeditious method available. (For a review of critical care transport, see Volume 2, Number 4 of EMCC: “Air Transport Of The Critically Ill Trauma Patient.”)
Trauma patients with hemorrhagic shock will likely require a surgical intervention in the operating room for definitive hemorrhage control. If a patient initially presents at a community hospital, transfer should begin as soon as the initial life threats are addressed. Transfer should not be delayed for any additional imaging.
Patients with severe hyponatremia requiring HTS administration should be admitted to an ICU.
Jeffrey A. Holmes, MD
February 4, 2013