Review of Issues and Challenges of Practicing Emergency Medicine Above 30,000-Feet Altitude: 2 Anonymized Cases.
We present 2 anonymized cases to identify issues and challenges associated with long-haul in-flight medical emergencies. The first case involved a middle-aged man with a history of carditis on a systemic steroid who developed vomiting and rigor. Four physicians, including a pediatric intensivist, responded to the emergency call. In the second case, a pediatric trainee who was the only onboard medical personnel was summoned for help when a middle-aged man developed acute shortness of breath while traveling on a commercial flight. The cases illustrate the challenges and issues on the critical decisions of diagnosis, resuscitation, and whether the flight had to be returned or diverted. An extensive literature search is made to summarize the evidence available for these decisions and challenges. Epidemiology and outcomes associated with these medical emergencies are reviewed. In-flight medical emergencies are not rare. Physicians of all disciplines should be prepared to deal with these emergencies and make sensible decisions when equipment and resources are likely to be limited.
Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong. Electronic address: ehon@hotmail.com.
Kam Lun
KL
Hon
Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong.
Karen Ka Yan
KK
Leung
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000337:Aerospace Medicine; D000368:Aged; D000531:Altitude; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D003975:Diazepam / Q000627:therapeutic use; D004417:Dyspnea / Q000209:etiology; D004635:Emergency Medicine; D006801:Humans; D007251:Influenza, Human / Q000150:complications; D008297:Male; D009041:Motion Sickness / Q000150:complications / Q000175:diagnosis*; D009205:Myocarditis / Q000150:complications / Q000188:drug therapy; D009325:Nausea / Q000209:etiology; D016584:Panic Disorder / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D014839:Vomiting / Q000209:etiology
D000305:Adrenal Cortex Hormones; D014151:Anti-Anxiety Agents; D003975:Diazepam