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Saving Lives in The South Pacific and Beyond with a little bit of Kiwi ingenuity and a 16fr gastric tube


Angela Coward
New Zealand Air Ambulance Service, NZAAS, COASTN Committee Member



Angela Coward is the Clinical Nurse Manager for New Zealand Air Ambulance Service. She has been a flight Nurse for the past 9 years, with seven of those years being in remote and rural Australia. In 2015 Angela relocated to New Zealand to pursue the unique opportunity of being involved in setting up the new NZAAS Service as it operates today both domestically and Internationally. Angela has completed post graduate certificates in aeromedical retrieval and critical care.



"Saving lives in the South Pacific and Beyond". The presentation is a case study. The scene - a remote island in the South Pacific Ocean. The environment and referral facility is resource poor. The patient is a young local woman with a background of recent bowel resection and anastamosis. She is septic and in multi system failure with significant and worsening renal function and associated hyperkalaemia as well as hypoglycaemia. The patient deteriorates while the retrieval team are enroute and is returned to theatre for a peritoneal washout and formation of defunctioning stoma. Without the option of CVVHDF or any other incarnation of dialysis on the island the team perform peritoneal dialysis using an improvised drain tube and a few bags of fluid. This buys sufficient time for the team to safely transport the patient for eight to ten hours to definitive care.

The case study will highlight the value of creative thinking and inventiveness in the resource poor environment that is our playground, in this case a small Island 1627NM from Auckland and asks the questions where to in the future? Is Peritoneal Dialysis a viable treatment option in remote Islands if so, who gets it, when should it start and when should it stop?  How do we go about providing education to ensure that it is carried out safely and appropriately? Is it reasonable to assert that retrieval teams could more frequently use a simplified method of Peritoneal Dialysis to buy time between receiving and handing over patient care.



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