Patient transfer to CT

Published 03/08/2023

Patient transfer to CT




RIJ CVC & left radial arterial line


1L crystalloid at 100ml/hr




FM, FiO2 0.4, RR 25, SpO2 94%, crackles bibasally


Transfer monitor, transfer bag

Clinical Setting

I: You are the ICU registrar transferring the patient for a CT scan of his abdomen

S: You have just arrived at CT

B: 70M was admitted to HDU post Hartman’s procedure for acute large bowl obstruction (2o probable new colonic mass), 5 days ago. He continues to have abdominal pain and persistent inflammatory markers, so the ICU consultant on duty decided he will have a CT CAP to assess the source of ongoing infection. PMHx T2DM, HTN. NKDA Abx to Tazocin. SHx: Independent of ADLs, with ex-tolerance up to 1 mile twice weekly. TEP: Full escalation

A: You are there to as support for the transfer

R: Called for help

Potential Clinical Course

  • Initially A own, B SpO2 94% on FiO2 0.4 FM, crackles bibasally C HR 120 bpm SR, BP 110/60, CVP 16, D GCS 15/15
  • Patient starts having a tonic-clonic seizure
  • The seizure self-terminates; however, patient’s GCS remains E1V1M4, with airway compromise.
  • SpO2 drop 95%->75%->35% and progresses to respiratory arrest if emergency intubation is delayed.
  • (The scenario can be run as a full transfer or as “just arrived in CT” based in a sim suite).

Info Sheet For Faculty

  • Initial settings:
    • SpO2 94% on FiO2 0.4 FM
    • RR 25/min
    • Bilateral air entry, crackles bi-basally
    • HR 120bpm, SR
    • BP 110/60, CVP 16,
    • T 38.8


  • Progress to:
    • SpO2 75% on FiO2 0.4 FM
    • (post-seizure) Obstructing airway
    • HR 130 bpm
    • BP 111/57, CVP 18  


  • If not intubated:
    • SpO2 35%
    • Absent breath sounds
    • Increase HR to 80 bpm SR
    • Progressing to cardiac arrest


  • If intubated:
    • SpO2 97% on FiO2 1.0
    • HR 110bpm SR
    • BP 90/60.

Faculty Roles

Bedside Nurse 1:

  • You are a senior ITU nurse
  • You are looking after a 70M post Hartman’s procedure for acute large bowl obstruction 5 days ago. He continues to spike temperatures and has abdominal pain. You have come on the transfer to CT for him to have an CT abdo.
  • When you are at CT patient has a tonic-clonic seizure and drops his GCS following it.
  • You take direction well, and can perform tasks asked of you in a timely fashion.
  • You wonder if CT is the most appropriate place to intubate someone.



  • You can put out calls if asked
  • Beyond that you do not know how to help


Anaesthetic SpR if called:

  • You are experienced, but let the ITU team lead on the situation
  • If scenario is not progressing you wonder if intubation needs to happen quicker
  • You wonder if CT is the safest place to intubate or perhaps moving to a place of safety is more appropriate


HiLLO: 5