Flightmed archive for December-2002
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Flightmed archive for December-2002



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Re: Flight Physiology



As an add-on, and perhaps this is unique to our program, but we have noticed the greatest risk (of STAT interventions and changes in patient condition) seems to occur while descending through 10,000'(Cabin altitude often only changing from 4000' to 2000' or so), the landing and ground transport to the hospital after 3-8 hour flights. Our suspicion is that it is due as much to a relaxation on the part of the conscious patient (as "almost there") as to altitude/pressure changes. 

However we have noticed the same in many critical and/or sedated/intubated/paralyzed patients - so are starting to wonder if this phenomenon has been noticed by anyone else?

Fly Safe. 
Ken L-W CCEMT-P/WMT

Duct tape is like the force, it has a light side and a dark side, and it holds the universe together.


--- message from "Wesley Copeland Sr., MICT, NREMT-P, FP-C, CCEMTP" <wcemt@terraworld.net> attached:


Allan,
 
To give a generic answer to your question is difficult the manner in which you utilize flight physiology will be based largely on your patients condition.  High altitude basically forces you to add another list of concerns to your overall management of the patient.  I would break it down into three primary categories.  The most important aspect to consider are the effects altitude will have on your patient before you ever leave the ground so you can prevent a problem before it happens.  Like knowing that you will have volume changes in your ET cuff, a simple pneumothorax can become a tension pneumo at altitude, dehydration may occur, FIO2 will be affected and changes in O2 therapy may be needed, etc. etc.  The second need arises when your patient has a problem in flight, much like "a combative patient is hypoxic until proven other wise".  If your patient deteriorates during a altitude change or shortly after, you need to take your physiology knowledge and rule out the possibility that the problem is altitude related and if so take corrective action.  The third aspect, which is frequently overlooked, is the effect flight will have on you and your fellow crew members.
 
Hope this helps,
 
Wesley Copeland Sr.,  FP-C
----- Original Message -----
Sent: Tuesday, December 03, 2002 8:30 AM
Subject: Flight Physiology

     Hi all - I've got a question for those of you who are very experienced in the realm of fixed wing transport: Exactly how do you apply the principles of flight physiology to your patient assessment and management?
      
       I'm quite familiar with basic flight physiology; the gas laws, the stressors of flight, etc....but what I mean is, how do you use that info?
      
       My experience is almost exclusively with low-altitude helicopter transport - where the effects of changing altitude aren't much of a factor - so I'm just curious to learn what little tricks and assessment techniques you airplane types routinely use during patient preparation and transport. Thanks!

-Allan            



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