Air Travel

During a flight, all physicians should be asked among the passengers for help in case of illness. In addition, commercial airlines have typically a first-aid equipment, including an automatic external cardioverter defibrillator, and some medications. The flight crew now has a better first aid training than before. Although doctors who provide sick or injured passengers assistance, are generally protected against lawsuits by the example of the Good Samaritan, they should avoid to be active on their training or their practical experience also.

causing air travel or aggravate certain health problems, some (contraindications and complications s.) should not be flown, and others can cause discomfort. Serious complications are rare. During a flight, all physicians should be asked among the passengers for help in case of illness. In addition, commercial airlines have typically a first-aid equipment, including an automatic external cardioverter defibrillator, and some medications. The flight crew now has a better first aid training than before. Although doctors who provide sick or injured passengers assistance, are generally protected against lawsuits by the example of the Good Samaritan, they should avoid to be active on their training or their practical experience also. For more information on air travel are obtained in the medical department of the major airlines or at the German Academy for flight and travel medicine (in the US: www.faa.gov). Contraindications and complications state risk intestinal obstruction, the pressure drop in the aircraft cabin leads to the expansion of air or gases in body cavities *. This can cause pain, tissue damage, or both thoracic or abdominal surgery when recently made (<10 days), the pressure drop in the aircraft cabin leads to the expansion of air or gases in body cavities *. This can cause pain, tissue damage, or both, heart disease, severe O2 desaturation *, † immunodeficiencies, severe acquisition or transmission of infections infection, highly contagious The acquisition or transmission of infections, recent intraocular injection of gas, the pressure drop in the aircraft cabin leads to the expansion of air or gases in body cavities *. This can cause pain, tissue damage, or both jaw immobilization (unless the device has a quick-release device) aspiration (z. B. If vomiting occurs due to air and sea sickness) myocardial infarction when complicated and previous in the 6 weeks O2 desaturation *, † myocardial infarction when uncomplicated and within previous 4 weeks. O2 desaturation *, † pneumothorax The pressure drop in the aircraft cabin leads to the expansion of air or gases in body cavities *. This can cause pain, tissue damage, or both Pulmonary bubbles or voids, large, the pressure drop in the aircraft cabin leads to the expansion of air or gases in body cavities *. This can cause pain, tissue damage, or both pulmonary dysfunction, severe O2 desaturation *, † Unstable angina O2 desaturation *, † * Risk mainly at high altitude. Low-level flights (<5,000 ft [1,524 m], z. B. rescue helicopter), lead less frequent problems. † When flying is necessary, supplemental O2 should be available. The air pressure changes in cabin pressure line airplanes and jet is only up to one equivalent of a height of 1830-2440 m, not balanced on the sea level pressure. The pressure drop may deteriorate by an expansion of air or gases in body cavities different states. In passenger aircraft and jet aircraft, the free air expands into the body cavities by about 25%. Untreated dental problems or fresh dental treatments can cause pain when the barometric pressure changes. In individuals with upper respiratory infections or allergic rhinitis may for obstruction of the eustachian tube or sinus openings come (which is a Barotitis media or may cause a Barosinusitis). Frequent yawning or swallowing closed nose during the descent, the use of decongestant nasal sprays or using antihistamines before or during the flight prevented or often relieves these conditions. Some people suck during landing candy or chewing gum. Air travel is contraindicated in patients who have a pneumothorax, or with a certain probability to develop a (z. B. with large pulmonary bubbles or cavities), and (in patients with air trapping z. B. at a incarcerated intestinal loop, less than 10 days of a thoracic or abdominal surgery or intraocular gas injection), because even a slight expansion can already lead to pain and tissue damage. Water in devices should be replaced with air with air-filled balloons or cuffs (z. B. feeding tube, urinary catheter). Colostomy should create a large bag and adapt to frequent changes because of the extent of intestinal gases. Children Children are particularly susceptible to Barotitis media and should have something to drink during the landing approach or get food to facilitate swallowing, which can create a pressure compensation. Infants can be resolved or get a bottle or a pacifier. Precautions for children with chronic diseases (eg. As congenital heart disease, chronic lung disease, anemia) are the same as for adults with these diseases. The fast jet lag traveling over time zones disrupts the normal circadian rhythm (circadian rhythm sleep disorders: Circadian rhythm sleep disorders type jet lag (jet lag disorder)). Bright sunlight keeps time. Because bright sunlight resets the internal clock in the late afternoon, the beginning of the normal bedtime delayed. The early morning light presents the body clock, so bedtime starts earlier than expected. Thus, a prudent approach to the action of light help to adapt, especially on the days of arrival in a new time zone. For example, could people who travel to the west, to maximize their exposure to bright light in the afternoon to delay bedtime. People who travel to the east could maximize light exposure to light in the early morning hours in order to facilitate the awakening and the earlier bedtime. Short-acting hypnotics (Commonly used oral hypnotics) may possibly help some people fall asleep (destination) in the corresponding right time when they travel to the east. However hypnotics may have adverse effects such as daytime sleepiness, amnesia and nocturnal insomnia. Long-acting sleeping pills increase the risk of uncertainty and falls in advanced age and should therefore be avoided in the elderly. Melatonin, a hormone produced by the pineal gland, has an influence on the sleep, but there are no large-scale, placebo-controlled trials for the therapeutic administration of melatonin (melatonin). The intake of melatonin (0.5-5 mg po before the desired sleep time) can help those who need to sleep earlier than usual, because they travel across several time zones to the east. Some doses have to be adjusted to compensate for the temporal changes. Thus, can. B. require insulin dosage, and the time depending on the number of crossed time zones, the time spent at the arrival time of the available meals and activities to adapt. The glucose levels should be checked regularly. Thus, the plasma glucose levels should be increased because so many changes affecting the values ??and strict control is more difficult, thus increasing the risk of hypoglycemia. Treatment plans are aimed to better the elapsed time as the local time. Reduced O 2 partial pressure in passenger aircraft at cruising altitude (typically 2440 m) of the O2 partial pressure decreases by about 25% compared to the pressure at sea level, which, due to the O2-Hb dissociation curve (oxyhemoglobin dissociation curve.), A decrease in the arterial O2 saturation caused by only about 4.4%. This decline may, however, be significant for people with severe heart or lung disease (s. Contraindications and complications), but is harmless for most people, but some people report after a period of 3-9 h at this level of complaints (eg. These include headache, malaise). In general, anyone who can go up to 50 m wide or a landing and whose disease condition is stable, can tolerate the normal conditions in an aircraft cabin without additional O2. Though people with moderate or severe pulmonary diseases (eg., Asthma, COPD, cystic fibrosis), heart failure, anemia (Hb <8.5 g / dl), severe angina pectoris, sickle cell disease (but not carriers of the trait) and many congenital heart disease Get in trouble. Such patients may usually with a special equipment for continuous O2 transfer that is made by the airline available to fly safely. Lightweight ankle edema due to venous stasis usually develop on long-haul flights and should not be confused with a heart failure. Smoking can increase a slight hypoxia and should be avoided before the flight. Hypoxia and fatigue increase the effects of alcohol. Low humidity in the cabin can occur due to very low humidity in aircraft for the dehydrogenation. This can be prevented by proper hydration and avoiding alcohol. Contact lens wearers and people with dry eyes should instil artificial tears to prevent corneal irritation caused by dehydration. Sickness sickness is often triggered by turbulence and vibrations and aggravated by heat, fear, hunger or overeating (sickness). Symptoms may include nausea, vomiting, sweating and dizziness. Motion sickness can be minimized before and during the journey by a reduced intake of food, fluids, and alcohol. to fix his eyes on a stationary object in the distance or the horizon may help or (z. B. on the ship), to lie down with eyes closed. Other measures include the selection of a seat position at which the movement of the ride vehicle can be felt (z. B. in the middle of the aircraft above the wing), refraining from reading, and the use of a small fan or fan. A Scopolaminpflaster or a non-prescription or prescription antihistamine is often useful, especially when it was taken before the trip. However, these drugs can have drowsiness, dry mouth, confusion, falls and other problems in older people result. Pregnancy uncomplicated pregnancy after the 36th week of pregnancy is not a contraindication for air travel. High-risk pregnancies need to be assessed individually. A flight in the 9th month usually requires the confirmation of a medical practitioner about the expected date of birth, which must not be older than 72 hours. However, the terms and conditions of the airline may vary. The seat belt should be applied under the abdomen and across the hips. In order to avoid any impact on the development of the fetal thyroid, pregnant women should avoid prolonged use of tablets for disinfecting water containing iodine. Pregnant traveling to areas should consider moving Travel in GeBiTe where malaria is endemic, because malaria can be virulent in pregnant women. Mefloquine appears to be safe during all three trimesters of pregnancy. Pregnant women should be especially careful attention to the cleanliness of food and well wash your hands while traveling. Psychological stress hypnosis and behavioral training show in some people with fear of flying or claustrophobia effect. Anxious passengers can benefit from a short-acting anxiolytic that before and - is taken during the flight - depending on the flight duration. Hyperventilation often simulated heart disease and can cause tetanieähnliche symptoms. Anxiety, panic and hyperventilation can cause paranoia and fear of death. Psychotic tendencies may become acute during the flight and be disruptive. In patients with violent or erratic behavior, an aide must be present and carried out an adequate sedation. Disabilities Deep vein thrombosis can develop at any sitting for a long time, and cause a pulmonary embolism. Risk factors include all the factors that play a role in other deep vein thrombosis (for example, a previous deep vein thrombosis, pregnancy, use of oral contraceptives-see table. Risk factors for venous thrombosis). Frequent walking around (every 1-2 hours), short exercises in sitting and adequate hydration are recommended, although the benefits of these measures is not occupied by studies. Air turbulence air turbulence can lead to sickness or injury. While seating belts should always be created. Other aspects Most implanted assistive devices such as pacemakers and cardioverter defibrillator are effectively protected against interference with flight safety equipment. However, the metal parts of some of these devices as well as orthopedic prostheses and braces can trigger a security alert. A doctor's letter should be included, to avoid problems in the security check. People with special dietary and medical needs should carefully plan and carry out their own food and supplies with them. With a few days lead time, most airlines are able passengers appropriate accommodation with physical disabilities and special needs, such as O2 therapy. Wheelchairs can be rented at most airlines, but it is advisable to inquire beforehand. Some airlines also accept passengers with highly specialized equipment (eg. As infusions, respirators), provided that an appropriate monitoring of the passenger is guaranteed and the particular concerns were clarified in advance. If a traveler due to a serious illness can not be accommodated on a normal flight, an air ambulance needs to be commissioned.

Health Life Media Team

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