Treatment in the air

BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7001.391 (Published 05 August 1995) Cite this as: BMJ 1995;311:391
  1. Michael Bagshaw
  1. Senior aviation physician British Airways Health Services, PO Box 10, Heathrow Airport, Hounslow, Middlesex TW6 9JA

    Patient might not have survived return to airport

    EDITOR,--D R Farquhar-Thomson and T Skinner question aspects of the management of the tension pneumothorax that occurred on a flight from Hong Kong, when Professor Wallace and Dr Wong used equipment from the British Airways medical kit, together with some ingenious improvisation.1 They query the decision not to land the aircraft or to decrease its altitude from 10000 m. At cruising altitude the cabin altitude is maintained by the pressurisation system at the order of 1830 m. Further reduction in cabin altitude is limited by structural considerations: to achieve a cabin pressure equivalent to the pressure at sea level it would be necessary for the aircraft to descend to 3000 m. This was not possible at the time of the incident because of high ground and because of constraints imposed by air traffic control, but it would have increased the ambient air pressure by only 20%, which would have been of little significance in a tension pneumothorax. A return to Hong Kong was considered, but the passenger is unlikely to have survived the time that this would have taken.


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