Miscellaneous Flashcards
What are the diagnostic criteria for ARDS?
An acute lung injury - within one week of the insult
Bilateral infiltrates on a chest x-ray, not explained by other lung pathology
Respiratory failure not explained by fluid overload
A Decreased PaO2/FiO2 ratio
A patient with COPD has saturations of 95% OA and MRC score of 1. They want to know if they need further investigations before they fly
No. No HCT required . Not meeting criteria for in flight oxygen
A patient with COPD has saturations of 95% OA and MRC score of 3. They want to know if they need further investigations before they fly
Yes , given MRC 3 , guidelines recommend 6MWT or SWT and if sats <84% review if hx of hypercapnia. If yes then need HCT, if no then inflight O2 @ 2l/min.
If sats on 6MWT/ SWT are > 84% then no need for HCT/ in flight O2
A patient with COPD has saturations of 91% OA and not on LTOT. They want to know if they need further investigations before they fly
Yes. Is there a history of hypercapnia ? If Yes then need HCT, if no then in flight O2 @ 2l/min
A patient with COPD has saturations of 91% on 1L LTOT. They want to know if they need further investigations before they fly
If known T1RF - no , just increase LTOT by 2l/min
If known T2RF - yes , needs HCT
Who needs a hypoxic challenge test for flying ?
- those with sats ≤ 95% , not usually on LTOT and at risk of hypercapnia OR sats < 84% on 6MWT or SWT with concerns re hypercapnia
- severe asthma with persistent symptoms or frequent exacerbations despite optimal treatment regardless of SpO2 at sea level
- ILD patients with sats <95% on exercise and resting sea level PaO2 ≤9.42 or TLCO ≤ 50%
- Severe chest wall deformity / severe resp muscle weakness FVC <1L
- Those with existing or previous hypercapnia and those at risk of T2RF already on LTOT
What HCT results indicate need for in flight O2 ?
PaO2 < 6.6 or Sats <85%
Patient with IPF wants to know if they need in flight O2 . There sats are 96% following 6MWT
No , HCT not req and in flight O2 not required
Patient with IPF wants to know if they need in flight O2 . There sats are 92% following 6MWT and they are not on LTOT
Need ABG:
- if PaO2 < 9.42 on room air then need to review TLCO. If TLCO < 50% predicted then need in flight O2 at 2l/min
- if PaO2 > 9.42 then still review TLCO . If <50% predicted then should have HCT. If more then doesn’t require HCT
Patient with IPF on LTOT wants to know if they need in flight O2 .
Yes , 2L greater than usual prescription
What are recommendations for CF patients when flying ?
Review spirometry if FEV1 <50% should have HCT . If sats <90% will need in flight O2
What is the advice following thoracic surgery and air travel?
Four weeks for non essential travel , 2 weeks for essential
What is the advice for air travel following TBB/TBNA/EBUS/Endobronchial valve insertion?
Those with no PTX on X ray should wait 1 week
What is the advice for flying with PTX?
Can’t fly with untreated PTX
Can fly 1 week after resolution of PTX
Be aware those high risk of recurrence
What is the advice for patients who develop sinus barotrauma after flying ?
Topical / oral decongestants and appropriate analgesia.
If allergic component intranasal steroids for 1 week prior to travel and /or oral corticosteroids
Symptoms and signs of barotrauma should have resolved prior to flying
What is the advice for air travel following otitis media ?
Advised not to fly for 2 weeks
What are the viral infections you are advised not to fly with?
Measles , chicken pox , mumps , SARs, MERS, COVID
When can patients with TB fly?
Smear positive patients must not fly until there are two consecutive smear negative samples on treatment
Those starting TB treatment when all info not available should not fly for at least 2 weeks
For those who are smear negative treatment should render them non infectious in 2 weeks
For MDR/XDR TB this is prohibited until 2 negative samples produced and clinical evidence of improvement
Extra pulmonary TB no restrictions
When can patients with Pneumonia fly?
Air travel should be postponed for 7 days in those with sats < 94%
What is the advice for those with OSA/OHS re air travel?
Daytime flights where posssible and take CPAP in hand luggage
Avoid EtOH/sedation
If night flight should use CPAP, if day avoid falling asleep
What is the advice for muscle wall weakness for air travel
FVC < 1L then HCT
If can’t tolerate spiro then consider 6MWT /SWT
What is the advice we provide to avoid VTE with air travel?
Ensure hydrated , avoid alcohol , keep mobile , compression stockings , for high risk patients LMWH ie 40mg Enox /DOAC for long haul (6-8 hr) flight
Low risk - all
Mod risk- over 60, preggo , minor surgery , extensive varicose veins
High risk- precious VTE (and not on anticoag) , thrombophilia , 6/52 major surgery , malignancy
How long should air travel be delayed after acute PE/DVT?
2 weeks
For pulmonary HTN what NYHA category are patients advised to have in flight O2 ?
NYHA III or IV