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Fitness to Fly

Fitness to Fly. The Problem. Every year 2 billion people fly Cheap travel started 30 years ago 40-50 yr olds now 70-80 yrs Older people have more disposable income Families spread round globe Sick and disabled want to fly too. Cabin environment.

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Fitness to Fly

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  1. Fitness to Fly

  2. The Problem • Every year 2 billion people fly • Cheap travel started 30 years ago • 40-50 yr olds now 70-80 yrs • Older people have more disposable income • Families spread round globe • Sick and disabled want to fly too

  3. Cabin environment • Cabin pressure decreases from 100kPa to 75kPa • Gas expands as pressure fall • Oxygen pressure falls • Air drawn from outside aircraft • Air is cold • Very little moisture – dry eyes etc

  4. Seating • Seats tightly packed • Immobility • Cramped seating • Spread of ariborne diseases

  5. Medical facilities • Flights over large oceans nowhere to divert to • Medical kit limited • No Doctor • Difficult environment to cope with medical emergency

  6. Assessment • Severe Asthma • Severe COPD • Severe restrictive lung diseases • Cystic fibrosis • Co-morbidity with illnesses causing hypoxaemia • Within 6/52 discharge for rti • Already requiring oxygen

  7. Who requires Oxygen • Haemoglobin oxygen sats 92% or less • Hb sats 95% don’t • Hb sats 92%-95% need assessment

  8. Gas volume changes • Middle ear • Ascending pos pressure in ear forces open eustachian tube no problem • Descending negative pressure in middle ear has opposite effect if eustachian tube dysfunctional get otic barotrauma

  9. Gas volume changes • Sinuses • Inability to equalise pressure in sinuses particularly frontal sinus can cause excruciating pain • Usually due to urti • Avoid flying • Ephedrine nasal drops • Oral pseudoephedrine

  10. Gas volume changes • Lung bullae • Risk of rupture not known • Closed pneumothorax don’t fly • Don’t fly following surgical proceedures that have left gas in delicate structure • Don’t dive in 24 hours before flying

  11. Deep vein thrombosis • Risk not known • Immobility in cramped position • Pressure on popliteal vein • Mild hypoxia • Mild dehydration

  12. Prevention • Regular exercises • Walking around cabin • Avoid alcohol drink fluids ++ • Avoid long periods of sleep • Below knee compression stockings • ? aspirin

  13. High risk flyers • Flights less than 4 hours • Usual advice • Stockings aspirin • Flights more than 4 hours • Clexane 40mgs on day of outward and inward flight • Pre-filled syringe • Given at airport

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