Travel by Air, Land & Sea

Question 1

if you need to carry oxygen supply onboard flights for traveling by air, is it allowed?

Answer 1

no - need to notify the airline 3 days or more before departure to request in-flight supllemental oxygen

Question 2

what is the max aircraft cabin air pressure?

Answer 2

max 8000 ft (2440 m) above sea level;
typically 6000-8000 ft

Question 3

who is at risk of experiencing an exacerbation of their underlying medical condition due to high air craft pressure?

Answer 3

anemia (including sickle cell disease), cardiopulmonary disease, cerebrovascular disease

Question 4

how does barotrauma occur in aircraft cabin?

Answer 4

pressure difference between enclosed body space (abdomen, middle ear, sinuses) and outside

Question 5

what are the risk factor of thromboembolic disease while flying?

Answer 5

clotting disorders, estrogen use, severe obesity, pregnancy, recent surgery or trauma, previous thrombosis

Question 6

how does the cabin air environment keep less conducive to the spread of most infectious diseases?

Answer 6

0.3 micro meter or bigger HEPA filter;
laminar airflow

Question 7

what are the most common in-flight medical events?

Answer 7

syncope/presyncope
respiratory symptoms
nausea or vomiting
cardiac symptoms
seizures

Question 8

what are the 2/3 of death in airplanes?

Answer 8

cardiac conditions

Question 9

how many first aid kids in airplane?

Answer 9

1 kit for 0-50 seats;
2 kits for 51-150;
3 kits for 151-250;
4 for >250;

Question 10

what is included in emergency medical kit in airplane?

Answer 10

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)

Question 11

what medical devices are available in airplane?

Answer 11

blood pressure cuff, stethoscope, cardiopulmonary resuscitation mask,
oropharyngeal airways
manual resuscitation device

Question 12

what is pulmonary embolism?

Answer 12

when a part of the DVT clot breaks off and travels to the lungs

Question 13

what is venous thromboembolism refer to?

Answer 13

deep vein thrombosis and pulmonary embolism

Question 14

is venous thromboembolism recurrent?
what is the long-term complications?

Answer 14

yes
post-thrombotic syndrome after a DVT
chronic thromboemblic pulmonary hypertension after a PE

Question 15

what is Virchow’s classic triad for thrombus formation?

Answer 15

1. venous stasis
2. vessel wall damage
3. hypercoagulable state

Question 16

what are the risk factors of venous thromboembolism?

Answer 16

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

Question 17

after air travel, the risk of thrombosis returns to baseline by .. weeks?

Answer 17

8 weeks

Question 18

what are the symptoms of DVT/PE?

Answer 18

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

Question 19

how to diagnose DVT?

Answer 19

duplex ultrasonographyho

Question 20

how to diagnose PE?

Answer 20

CT pulmonary angiography;
ventilation-perfusion scan (2nd line)

Question 21

how to treat DVT or PE?

Answer 21

anticoagulant medications -
injection:
unfractionated heparin;
low molecular weight heparin;
fondaparinux

oral:
apixaban, betrixaban, dabigatran, edoxaban, rivaroxaban, warfarin

Question 22

is graduated compression stocking recommended for long-distance travelers not at increased risk of VTE?

Answer 22

No;

Question 23

is there an evidence for an association between dehydration and travel-related VTE?

Answer 23

No

Question 24

what are the recommendations to prevent VTE for long-distance travelers?

Answer 24

1. calf muscle exercises
2. frequent ambulation
3. aisle seating when possible
4. graduated compression stocking (ONLY if at increased risk of VTE)

Question 25

where is the melatonin secreated from the body?

Answer 25

pineal gland

Question 26

what is the risk of melatonin?

Answer 26

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

Question 27

what are other alternatives of melatonin for jet-lag?

Answer 27

ramelteon - melatonin-receptor agonist;
tasimelteon - dual melatonin-receptor agonist

Question 28

what is the leading cause of nonnatural death among US citizens who die in a foreign country?

Answer 28

motor vehicle crashes

Question 29

which country has the highest crash death rate for US travelers?

Answer 29

dominican republic

Question 30

a good-quality helmet can reduce the risk for death by … % and for severe injury by … %

Answer 30

40%
70%

Question 31

what are risk factors for crashes?

Answer 31

alcohol-impaired driving;
bus travel;
mobile telephones;
country-specific driving hazards;
general driving hazards;
pedestrian hazards;
taxis or hired drivers

Question 32

most cruise lines do not permit pregnant people from … week?

Answer 32

24th week

Question 33

what is the most common medical complaints on cruise ships?

Answer 33

respiratory illness

Question 34

how is Legionnaires’ disease contracted?

Answer 34

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

Question 35

what is the most common cause of GI illness on cruise ships?

Answer 35

norovirus

Question 36

GI outbreaks on cruise ships also have been caused by contaminated food or water; most outbreaks were associated with ….?

Answer 36

Campylobacter;
Clostridium perfringens;
enterotoxigenic E. coli

Question 37

what are the risk factors for motion sickness?

Answer 37

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

Question 38

what are motion sickness symptoms?

Answer 38

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

Question 39

what are medications for motion sickness?

Answer 39

antihistamines (cyclizine, dimenhydrinate, meclizine, promethazine);
anticholinergics (scopolamine);
benzodiazepines;
dopamine receiptor antagonists (metoclopramide, prochlorperazine);
sympathomimetics (often with antihistamines)

Question 40

what is kids meds for motions sickness 2-12 years old?

Answer 40

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!