GASTROINTESTINAL

DISORDERS

CPT DONALD C PALMA MC

FLIGHT SURGEON
DIPLOMATE, PHILIPPINE SPECIALTY BOARD OF
INTERNAL MEDICINE
FELLOW, PHILIPPINE COLLEGE OF PHYSICIANS
 OBJECTIVE

• To provide the students with the basic

knowledge on the management of patients with
Gastrointestinal disorders during Aeromedical
evacuation
 SCOPE OF PRESENTATION

• STRESSES OF FLIGHT
• GASTROINTESTINAL DISORDERS AND
MANAGEMENT
• PRE-FLIGHT/ IN-FLIGHT CONSIDERATIONS
• CONTRAINDICATIONS TO FLIGHT
 STRESSES OF FLIGHT

• Decreased Partial Pressure of Oxygen

• Increases myocardial workload, predisposing

compromised patients to arrhythmias, chest pain and
may lead to myocardial infarction.

• Consider cabin pressure altitudes less than 6000 feet for

cardiac patients and patient with increased FiO2
requirements.
 STRESSES OF FLIGHT

• Barometric Pressure Changes

• Gas expansion in the GI tract may cause:

• Abdominal discomfort
• Decreased lung expansion and volume
• Nausea and vomiting
 STRESSES OF FLIGHT

• Gravitational Forces

• Take - off may increase returning blood flow and cardiac

workload
 STRESSES OF FLIGHT

• Thermal Changes

• Underlying condition makes patient more sensitive to

thermal changes and susceptible to motion sickness
 STRESSES OF FLIGHT

• Fatigue

• Cumulative effect of stresses may exacerbate the

patient’s condition.
• Length of time in-flight
 GASTROINTESTINAL DISORDERS

• MOTION SICKNESS
• ACUTE ABDOMEN
• ABDOMINAL GAS EXPANSION
• PEPTIC ULCER DISEASE
• GASTROINTESTINAL BLEEDING
 MOTION SICKNESS

• ORGANIC MOTION SICKNESS

• Caused by a disease that affects the inner ear

• Results to sensitivity to labyrinth stimulation

• NON- ORGANIC MOTION SICKNESS

• Caused by: turbulence, hypoxia, fear, emotional

stress, visual stimuli, odor, hypoglycemia,
dehydration, caffeine, no food intake, dehydration
 PRE-FLIGHT/ IN-FLIGHT ASSESSMENT

• History taking, Physical examination

• Assess for signs and symptoms

• Medications if needed (Anti-emetics)

• Patient comfort/ decrease anxiety ( Instruct patient to take

slow, deep and relaxing breaths)

• Restrict head movements

• Have patient visually fixate on a stationary object

• Cool the patient

• If patient is vomiting:

• NPO

• Insert D5 containing IVF

• Medications
 ACUTE ABDOMEN
• INTESTINAL OBSTRUCTION

• ABDOMINAL SURGERIES

• ADHESIONS

• NEOPLASM

• PREGNANCY

• KIDNEY DISEASE

• RUPTURED VISCUS
 PRE-FLIGHT/IN-FLIGHT ASSESSMENT

• HISTORY AND PHYSICAL EXAMINATION

• Assess for signs and symptoms:

• Nausea/ vomiting ( bloody or coffee ground)

• Abdominal pain

• Fever and chills

• Dysuria, hematuria

• Hypotension
• Laboratory examinations (CBC, serum electrolytes)

• Assess Vital signs/ bowel sounds

• O2 supplementation

• NPO temporarily

• Insert NGT- if with gastric distention

• Medications
 ABDOMINAL GAS EXPANSION

• PRE- FLIGHT/ IN- FLIGHT ASSESSMENT

• Medical history and Physical examination

• Laboratory Examination

• Vital signs

• Signs and symptoms

• Severe abdominal pain/ tympanism upon

percussion
• NGT and rectal tubes

• Loosen clothing

• Position of comfort

• Medications
 GASTROINTESTINAL BLEEDING
• MEDICAL HISTORY

• Trauma to the GI tract

• Inflammatory/ Ulcerative Disease

• Response to stress

• Alcohol/ NSAIDs induced

• Coagulation abnormalities

• Hemorrhoids/ Fissures
• Signs and symptoms

• Dizziness

• Weakness

• Diaphoresis

• Hematemesis/ melena

• Pallor
 PRE-FLIGHT/IN-FLIGHT ASSESSMENT
• History and physical examination

• Vital Signs/ Monitor I&O

• Laboratory examinations ( latest hemoglobin)

• O2 supplementation

• IV access

• Medications:
• GASTROINTESTINAL
DISORDERS PRE-FLIGHT/IN-
FLIGHT ASSESSMENT
 PRE-FLIGHT ASSESSMENT

• History and Physical Examination

• Vital signs

• O2 supplementation if needed

• Medications needed

• Laboratory and diagnostic work up (CBC, serum

electrolytes)
 PRE-FLIGHT ASSESSMENT

• Equipment to carry for possible resuscitation

• Hook IV line and secure

 IN-FLIGHT ASSESSMENT

• Monitor VS

• Regulate the IVF

• O2 saturation

• Emergency medicines

• Prepare for resuscitation

CONTRAINDICATIONS TO FLIGHT

• GI bleeding- hemoglobin of less than 85 g/dl

• Patients are transported if the anemia is chronic

and stable or there is no evidence of active
bleeding within 24 hours of flight
QUESTIONS?
THANK YOU
and
GOOD DAY!!!