When medical emergencies arise in flight, commercial airline flight crews may ask for help from onboard medical professionals. Qualified, active, licensed, and sober providers should volunteer to assist in the event of a medical emergency rather than decline out of fear of medicolegal reprisal. An understanding of the typically available resources, the hierarchy of authority, and medico-legal precedents can help providers feel confident in responding to these situations.
Our issue Assisting With Air Travel Medical Emergencies: Responsibilities and Pitfalls addresses the pathophysiology related to air travel and common causes of in-flight medical emergencies and discusses the medications and equipment commonly stocked by commercial airlines.
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Here are a few key points:
- Ventilatory compensation begins within minutes, but takes up to 24 hours for maximal effect; the renal response occurs over hours to days.
- Lactate accumulates due to tissue hypoxia and aerobic glycolysis. Type A lactic acidosis refers to that characterized by poor perfusion and acute hypoxia; type B lactic acidosis occurs in the absence of overt hypoperfusion or hypoxia.
- Mortality associated with hyperlactatemia occurs more often when buffer systems can no longer compensate and a lactic acidosis ensues.