The Clinician’s Guide to In-Flight Emergencies

Altered mental status

Presentation/Causes:

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

Management Approach:

• 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