Commercial in-flight medical emergencies: Difference between revisions
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*Identify yourself and level of medical training | *Identify yourself and level of medical training | ||
*Ask a flight attendant to obtain the emergency medical kit (EMK) and administer oxygen as needed | *Ask a flight attendant to obtain the emergency medical kit (EMK) and administer oxygen as needed | ||
====Patient assessment==== | |||
#Identify chief complaint and HPI | |||
#Obtain vital signs (pulse and blood pressure) | |||
#If you are unable to assess blood pressure by means of auscultation, assess it by palpating the radial pulse | |||
#*Assess mental status and if there are focal neurologic deficits | |||
#f the patient is in cardiac arrest, obtain and apply an automated external defibrillator (AED) | |||
##For patients with a pulse but a suspected cardiac problem, consider using an AED if it has monitoring capabilities | |||
##*The airline may require contact with a ground-based consultant before use | |||
*Initiate consultation with the ground-based consultant if not already initiated by the flight crew | *Initiate consultation with the ground-based consultant if not already initiated by the flight crew | ||
*Consider discussing administration of medications or intravenous fluids with ground-based consultant | *Consider discussing administration of medications or intravenous fluids with ground-based consultant | ||
*Aircraft diversion, ground-based medical assistance, or both should be coordinated with ground-based consultation | *Aircraft diversion, ground-based medical assistance, or both should be coordinated with ground-based consultation | ||
*Document the clinical presentation and care rendered | *Document the clinical presentation and care rendered and give documentation to medical personnel on arrival at the destination with transfer of care | ||
===Management of Syncope or Presyncope=== | ===Management of Syncope or Presyncope=== | ||
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*Provide oxygen | *Provide oxygen | ||
*If chest pain may be cardiac in origin, administe aspirin | *If chest pain may be cardiac in origin, administe aspirin | ||
*If systolic blood pressure is more than 100 mm Hg, consider administering sublingual nitroglycerin every 5 minutes | *If systolic blood pressure is more than 100 mm Hg, consider administering sublingual nitroglycerin every 5 minutes | ||
**Check blood pressure after each dose | **Check blood pressure after each dose | ||
*If the AED has monitoring capabilities, consider its use to evaluate the cardiac rhythm and evidence of ST-segment | *If the AED has monitoring capabilities, consider its use to evaluate the cardiac rhythm and evidence of ST-segment changes in the limb leads | ||
changes in the limb leads | *If symptoms resolve with the above measures, aircraft diversion is not typically required. Ground-based consultation can assist with diversion decisions | ||
*If symptoms resolve with the above measures, aircraft diversion is not typically required. Ground-based consultation | |||
can assist with diversion decisions | |||
==Source== | ==Source== | ||
Revision as of 03:47, 2 May 2014
Background
- 1 per 604 flights[1]
- 0.3% of cases died
Epidemiology[1]
- syncope or presyncope (37.4%)
- respiratory symptoms (12.1%)
- nausea or vomiting (9.5%)
- Cardiac symptoms (7.7%)
- Seizures (5.8%)
- Abdominal pain (4.1%)
- Infectious disease (2.8%)
- Agitation or psychiatric symptoms (2.4%)
- Allergic reaction (2.2%)
- Possible stroke (2.0%)
- Trauma, not otherwise specified (1.8%)
- Diabetic complication (1.6%)
- Headache (1.0%)
- Arm or leg pain or injury (1.0%)
- Obstetrical or gynecologic symptoms(0.5%)
Ear pain (0.4%)
- Cardiac arrest (0.3%)
- Laceration (0.3%)
Management
General Approach
- Identify yourself and level of medical training
- Ask a flight attendant to obtain the emergency medical kit (EMK) and administer oxygen as needed
Patient assessment
- Identify chief complaint and HPI
- Obtain vital signs (pulse and blood pressure)
- If you are unable to assess blood pressure by means of auscultation, assess it by palpating the radial pulse
- Assess mental status and if there are focal neurologic deficits
- f the patient is in cardiac arrest, obtain and apply an automated external defibrillator (AED)
- For patients with a pulse but a suspected cardiac problem, consider using an AED if it has monitoring capabilities
- The airline may require contact with a ground-based consultant before use
- For patients with a pulse but a suspected cardiac problem, consider using an AED if it has monitoring capabilities
- Initiate consultation with the ground-based consultant if not already initiated by the flight crew
- Consider discussing administration of medications or intravenous fluids with ground-based consultant
- Aircraft diversion, ground-based medical assistance, or both should be coordinated with ground-based consultation
- Document the clinical presentation and care rendered and give documentation to medical personnel on arrival at the destination with transfer of care
Management of Syncope or Presyncope
- Confirm breathing and pulse
- Move the patient to an aisle or galley, place the patient in a supine position with legs raised, and provide oxygen
- Check vital signs
- Most patients will be hypotensive immediately after the episode
- If the patient has diabetes, a glucometer from the patient or a fellow passenger may be used for glucose assessment
- A device may also be available in enhanced EMKs
- Most patients will recover spontaneously within minutes. Give oral fluids when possible
- Consider intravenous fluids only if the patient is persistently hypotensive and cannot take oral fluids or has another indication
Management of Chest Pain or Palpitations
- Check vital signs
- Provide oxygen
- If chest pain may be cardiac in origin, administe aspirin
- If systolic blood pressure is more than 100 mm Hg, consider administering sublingual nitroglycerin every 5 minutes
- Check blood pressure after each dose
- If the AED has monitoring capabilities, consider its use to evaluate the cardiac rhythm and evidence of ST-segment changes in the limb leads
- If symptoms resolve with the above measures, aircraft diversion is not typically required. Ground-based consultation can assist with diversion decisions