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Table 37 1 Contraindications to air travel
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Congestive heart failure1 Uncomplicated myocardial infarction within 3 weeks; complicated myocardial infarction within 6 weeks Post CABG within 2 weeks CVA within 2 weeks Uncontrolled hypertension Uncontrolled ventricular or supraventricular tachycardia Severe symptomatic valvular heart disease New or unstable angina Deep venous thrombosis unless the person is stable, receiving anticoagulant therapy, and has no pulmonary complications2 Nasal congestion unresponsive to therapy Pulmonary cysts Pneumothorax Active communicable tuberculosis or other communicable virulent infection (eg, measles, chickenpox) Breathlessness or hypoxemia Anemia (hemoglobin < 85 g/dL), sickle cell disease Postsurgery (eye, thorax, abdomen) within 2 3 weeks unless surgeon approves Emotionally unstable, agitated, or psychotic Pregnancy unless low risk, without complications, and less than 8 months
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Pregnant women may be permitted to fly during the first 8 months of pregnancy unless there is a history of complications of pregnancy or premature birth During the ninth month of pregnancy, air travel is not recommended; if travel is essential, a physician s authorization is required Infants less than 1 week old should not be flown at high altitudes or for long distances
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DeHart RL Health issues of air travel Annu Rev Public Health 2003;24:133 51 [PMID: 12428033]
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Oxygen should be made available for persons with cardiovascular, respiratory, or hematologic illness 2 Susceptible patients should wear support hose, perform leg exercises, and walk during flight Preflight low-molecular-weight heparin may also be indicated CABG, coronary artery bypass grafting; CVA, cerebrovascular accident
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Gallus AS Travel, venous thromboembolism, and thrombophilia Semin Thromb Hemost 2005 Feb;31(1):90 6 [PMID: 15706480] Hovens MM et al Aspirin in the prevention and treatment of venous thromboembolism J Thromb Haemost 2006 Jul;4 (7):1470 5 [PMID: 16839339] Low JA et al Air travel in older people Age Ageing 2002 Jan;31 (1):17 22 [PMID: 11850303]
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Patients with drug overdoses or poisoning may initially have no symptoms or they may have varying degrees of overt intoxication The asymptomatic patient may have been exposed to or may have ingested a lethal dose of a poison but not yet exhibit any manifestations of toxicity It is important to: (1) quickly assess the potential danger, (2) consider gut decontamination to prevent absorption, and (3) observe the patient for an appropriate interval
Poisoning
Kent R Olson, MD
Observation of the Patient
Asymptomatic or mildly symptomatic patients should be observed for at least 4 6 hours Longer observation is indicated if the ingested substance is a sustained-release preparation or is known to slow gastrointestinal motility or if there may have been exposure to a poison with delayed onset of symptoms (such as acetaminophen, colchicine, or hepatotoxic mushrooms) After that time, the patient may be discharged if no symptoms have developed and adequate gastric decontamination has been provided Before discharge, psychiatric evaluation should be performed to assess suicidal risk Intentional ingestions in adolescents should raise the possibility of unwanted pregnancy or sexual abuse
Assess the Danger
If the drug or poison is known, its danger can be assessed by consulting a text or computerized information resource (eg, Poisindex) or by calling a regional poison control center (Dialing 800-222-1222 will direct the call to the appropriate United States regional poison control center) Assessment will usually take into account the dose ingested (in milligrams per kilogram of body weight); the time interval since ingestion; the presence of any symptoms or clinical signs; preexisting cardiac, respiratory, renal, or liver disease; and, occasionally, specific serum drug or toxin levels Be aware that the history given by the patient or family may be incomplete or unreliable The manufacturer or its local representative may be able to provide information over the phone concerning the toxic ingredients in question and can be contacted directly or via the regional poison control center
THE SYMPTOMATIC PATIENT
In symptomatic patients, treatment of life-threatening complications takes precedence over in-depth diagnostic evaluation Patients with mild symptoms may deteriorate rapidly, which is why all potentially significant exposures should be observed in an acute care facility The following complications may occur, depending on the type of poisoning
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