Travel by Air, Land & Sea Flashcards
if you need to carry oxygen supply onboard flights for traveling by air, is it allowed?
no - need to notify the airline 3 days or more before departure to request in-flight supllemental oxygen
what is the max aircraft cabin air pressure?
max 8000 ft (2440 m) above sea level;
typically 6000-8000 ft
who is at risk of experiencing an exacerbation of their underlying medical condition due to high air craft pressure?
anemia (including sickle cell disease), cardiopulmonary disease, cerebrovascular disease
how does barotrauma occur in aircraft cabin?
pressure difference between enclosed body space (abdomen, middle ear, sinuses) and outside
what are the risk factor of thromboembolic disease while flying?
clotting disorders, estrogen use, severe obesity, pregnancy, recent surgery or trauma, previous thrombosis
how does the cabin air environment keep less conducive to the spread of most infectious diseases?
0.3 micro meter or bigger HEPA filter;
laminar airflow
what are the most common in-flight medical events?
syncope/presyncope
respiratory symptoms
nausea or vomiting
cardiac symptoms
seizures
what are the 2/3 of death in airplanes?
cardiac conditions
how many first aid kids in airplane?
1 kit for 0-50 seats;
2 kits for 51-150;
3 kits for 151-250;
4 for >250;
what is included in emergency medical kit in airplane?
antihistamine tab/injection; aspirin; atropine
bronchodilator,
dextrose (50%) and saline for infusion;
epinephrine (1:1000 and 1:10000);
lidocaine;
nitroglycerin tablets (0.4mg);
non-narcotic analgesic (325mg)
what medical devices are available in airplane?
blood pressure cuff, stethoscope, cardiopulmonary resuscitation mask,
oropharyngeal airways
manual resuscitation device
what is pulmonary embolism?
when a part of the DVT clot breaks off and travels to the lungs
what is venous thromboembolism refer to?
deep vein thrombosis and pulmonary embolism
is venous thromboembolism recurrent?
what is the long-term complications?
yes
post-thrombotic syndrome after a DVT
chronic thromboemblic pulmonary hypertension after a PE
what is Virchow’s classic triad for thrombus formation?
- venous stasis
- vessel wall damage
- hypercoagulable state
what are the risk factors of venous thromboembolism?
cancer (active);
estrogen use;
hospitalization, surgery, trauma (recent);
limited mobility;
obesity BMI 30 or more;
older age (after 40);
pregnancy and postpartum period;
previous VTE;
serious medical illness;
thrombophilia (inherited or acquired) or a family history of VTE;
air travel risk - height smaller than 1.6m and taller than 1.9m
after air travel, the risk of thrombosis returns to baseline by .. weeks?
8 weeks
what are the symptoms of DVT/PE?
DVT - pain or tenderness, swelling, warmth in the affected area, redness or discoloration of the overlying skin
PE - unexplained shortness of breath, pleuritic chest pain, cough or hemoptysis, syncope
how to diagnose DVT?
duplex ultrasonographyho
how to diagnose PE?
CT pulmonary angiography;
ventilation-perfusion scan (2nd line)
how to treat DVT or PE?
anticoagulant medications -
injection:
unfractionated heparin;
low molecular weight heparin;
fondaparinux
oral:
apixaban, betrixaban, dabigatran, edoxaban, rivaroxaban, warfarin
is graduated compression stocking recommended for long-distance travelers not at increased risk of VTE?
No;
is there an evidence for an association between dehydration and travel-related VTE?
No
what are the recommendations to prevent VTE for long-distance travelers?
- calf muscle exercises
- frequent ambulation
- aisle seating when possible
- graduated compression stocking (ONLY if at increased risk of VTE)
where is the melatonin secreated from the body?
pineal gland
what is the risk of melatonin?
may increase the frequency of seizures in people with epilepsy;
potentially induce proinflammatory cytokine production, thus, should not be taken by those with autoimmune diseases
what are other alternatives of melatonin for jet-lag?
ramelteon - melatonin-receptor agonist;
tasimelteon - dual melatonin-receptor agonist
what is the leading cause of nonnatural death among US citizens who die in a foreign country?
motor vehicle crashes
which country has the highest crash death rate for US travelers?
dominican republic
a good-quality helmet can reduce the risk for death by … % and for severe injury by … %
40%
70%
what are risk factors for crashes?
alcohol-impaired driving;
bus travel;
mobile telephones;
country-specific driving hazards;
general driving hazards;
pedestrian hazards;
taxis or hired drivers
most cruise lines do not permit pregnant people from … week?
24th week
what is the most common medical complaints on cruise ships?
respiratory illness
how is Legionnaires’ disease contracted?
by inhaling warm, aerosolized water containing the bacteria, Legionella;
through aspiration of Legionella-containing water;
typicaly human-to-human does not occur;
contaminated hot tubs are commonly implicated as a source of shipboard Legionella outbreaks
what is the most common cause of GI illness on cruise ships?
norovirus
GI outbreaks on cruise ships also have been caused by contaminated food or water; most outbreaks were associated with ….?
Campylobacter;
Clostridium perfringens;
enterotoxigenic E. coli
what are the risk factors for motion sickness?
age, sex, preexisting medical conditions, concurrent meds
-2-12 yrs esp susceptible;
->50 years are less susceptible;
pregnancy, menstruation, taking hormone replacement therapy or oral contraceptives
ppl with hx of migraines, vertigo, vestibular disorders
what are motion sickness symptoms?
Anorexia
Apathy
Cold sweats
Drowsiness
Generalized discomfort
Headache
Hyperventilation
Increased sensitivity to odors
Loss of appetite
Nausea
Salivation, excessive
Sweating
Vomiting or retching
Warm sensation
what are medications for motion sickness?
antihistamines (cyclizine, dimenhydrinate, meclizine, promethazine);
anticholinergics (scopolamine);
benzodiazepines;
dopamine receiptor antagonists (metoclopramide, prochlorperazine);
sympathomimetics (often with antihistamines)
what is kids meds for motions sickness 2-12 years old?
dimenhydrinate - 1-1.5mg/kg per dose;
diphenhydramine 0.5-1mg/kg per dose up to 25mg;
oversedating young children with antihistamines can be life-threatening!
no scopolamine!
