Dyspnea

Presentation/Causes:

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

Management Approach:


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  • 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.