Altered mental status

Presentation/Causes:

  • Seizures
  • Postictal states
  • Potential causes include metabolic derangement, infection, vascular pathology, intoxication, trauma, hypoxemia

Management Approach:


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  • Assess reversible cause of patient’s altered mentation
  • Determine blood sugar levels if possible; provide oral carbohydrates or IV dextrose
  • Use supplemental oxygen in patients with suspected respiratory compromise
  • Request descent to lower altitude
  • Recommend expedited landing if necessary

Syncope

Presentation/Causes:

  • Potential causes include dehydration, decreased arterial oxygen tension, altered eating patterns, fatigue

Management Approach:

  • Measure passenger’s blood pressure and pulse to assess intravascular volume depletion or bradycardia
  • Lay patient on floor with elevated feet 
  • For persistent hypotension, provide IV fluids
  • Check blood glucose
  • Stratify risk
  • Recommend diversion for elderly patients with persistent symptoms or history of cardiac disease

Trauma

Presentation/Causes:

  • Often results from blunt force trauma due to turbulence
  • Usually nonlethal

Management Approach:

  • Consider patient-specific factors such as age, medical conditions, use of anticoagulants
  • Offer cold compresses and analgesia
  • Place patient in non-weight-bearing position and use splints if fracture or dislocation suspected
  • Take history/perform examination in event of head injury
  • Monitor and reassess
  • Consider expedited diversion for serious injuries