Table 5.

Approach to common in-flight medical incidents.

Syncope	Assess vital signs, cardiovascular exam, and neurological exam. Recommend diversion for hypotension, arrhythmia, or suspected stroke.
Altered Mental Status	Assess for toxidromes. Administer oxygen, establish intravenous access and administer normal saline and dextrose 50%.
Seizure	Clear space around passenger. Administer sedative/anticonvulsant (benziodiazepine if available). Provide supportive care during post-ictal period. Recommend diversion for status epilepticus.
Chest Pain	Assess vital signs. Perform cardiovascular and respiratory exam. Administer oxygen, nitroglycerin, and aspirin. Recommend diversion for arrhythmia, abnormal vital signs, or concern for myocardial infarction.
Respiratory Asthma Exacerbation Suspected Pneumothorax Suspected Congestive Heart Failure	Administer inhaled bronchodilator and oxygen. Consider intravenous steroid for moderate to severe symptoms. Consider intramuscular epinephrine (0.3 to 0.5 ml of 1:1000 solution) for severe symptoms. Perform needle thoracostomy for suspected tension pneumothorax (unequal breath sounds, chest pain, dyspnea). Recommend diversion. Administer oxygen, assess vital signs and establish intravenous access. Administer oral nitroglycerin and intravenous diuretic. Recommend diversion.
Allergic Reaction	For mild allergic reaction, administer intravenous antihistamine and corticosteroids. For severe allergic reaction/anaphylaxis, administer intramuscular epinephrine (0.3 to 0.5 ml of 1:1000 solution).
Gastrointestinal Nausea/Vomiting Diarrhea	Administer antiemetic. Establish intravenous access and administer normal saline. Establish intravenous access and administer normal saline.
Pregnancy Complications	Assess vital signs and establish intravenous access. Recommend diversion for abdominal pain or vaginal bleeding.