The Clinician’s Guide to In-Flight Emergencies

Dyspnea

Presentation/Causes:

• Reduced oxygenation can cause exacerbations respiratory disorders (eg, COPD, pulmonary hypertension)

Management Approach:

• Provide supplemental oxygen
• Use albuterol metered-dose inhaler to treat bronchospasm
• Use on-board equipment or improvise in the event of pneumothorax in unstable patient
• Advise descending to lower altitude

Acute infections

Presentation/Causes:

• Contagion a risk in confined quarters of an airplane

Management Approach:

• Try to isolate patient by preventing movement around cabin and relocating neighboring passengers
• Isolate body fluids
• Use bag-valve mask if CPR is needed (or perform compression-only CPR)
• Discuss potential quarantine and government reporting requirements with flight crew and ground-based services if communicable disease is suspected

Psychiatric emergencies

Presentation/Causes:

• Potential stressors (eg, lengthy check-in, enhanced security, delayed flights, cramped cabins, alcohol consumption)
• Acutely agitated patients pose safety concerns

Management Approach:

• Determine potential organic cause for behavior (eg, hypoglycemia)
• Try to deescalate the situation
• In the absence of sedatives, physical restraints might be necessary to ensure safety of other passengers

CPR=cardiopulmonary resuscitation; AED=automated external defibrillator; ACS=acute coronary syndromes; MI=myocardial infarction; IV=intravenous

Source: Nable et al. N Engl J Med. 2015;373:939-945.