question?

[drdr0682 at aol.com]

 I gave a talk at the recent AMTC in Minneapolis on PE/DVT. This included a discussion of PE/DVT in both the general patient population as well as the risks of PE/DVT in aircrew. In particular, I cited the case of a flight nurse on a long distance air ambulance service who had intemittent PEs for a year before diagnosis. 

I talked about what the literature says about risks in patients/crew who fly often - and there is some mild to moderate increased risk. 

The main thing that patients or aircrew that are relatively limited in mobility because of their jobs can do, is to keep the muscles moving in their lower extremities. Ideally, this means walking around. If that is not possible exercising the muscles in the feet, ankles and legs, while in the seat, is an alternative. 

Coincidentally, last night I was flying home from New Orleans on American Airlines and thumbing through their in-flight magazine. They devoted a whole page in the back of the magazine towards educating passengers about DVT risk and flying. They suggested staying well hydrated as there is some literature suggesting that the dehydration of higher altitude flight contributes to PE/DVT development. They also offered suggestions on exercises in the seat. They were fairly common sense like:

Dorsiflex the toes (point the toes and feet toward the head while seated) of both feet repetitively 10-15 times. Then plantar flex the feet (point the toes at the ground) a similar amount of time. 
Swing your feet in circles at ankle joint 10 -15 times. 
Flex your knees hips and bring your legs up to the chest 5-6 times. (Good luck finding room in a standard coach airline seat).Repeat as desired (and as tolerated by nearby passengers).

You get the general idea. 

The other regarding PE/DVT risk for aircrew that is not talked about is risk assessment at the time of hire and/or flight physical exam. I don't think there is any evidence - yet - that prospective crew need Factor V Leieden assessments or Protein C or S evaluation; but certainly historical risks should be sought. 

Prior history of PE/DVT
Family history
Smoking
Birth control pill use
Active Cancer
Recent Surgery or immobilization of a lower extremity.
Recent trauma to an extremity
Other recent long trips unrelated to work - car or other airplane flight.

These all should be screened for. Whether or not a crew member can fly with any of these risks is up to the program and/or the Occupational Health physician. In most of the above scenarios, I think they can, but they should be warned to take any potential symptoms very seriously and seek care. 

Symptoms of PE can be very, very subtle and are often ignored. Even when DVTs are present, there may be no symptoms. So an assessment of the crew's risk for PE/DVT should preceed flight and symptoms should be respected if they occur. 

Hope this helps. 

David Ross, DO FACEP
Colorado Springs CO



 


 

-----Original Message-----
From: jaspal singh <shahsdestiny42 at gmail.com>
To: flightmed at flightweb.com
Sent: Tue, 11 Nov 2008 3:47 pm
Subject: question?










how can we attempt to decrease the blood stasis problem on long flight?
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