Air evacuation of critically burned patients.

We analyze the repercussions of air evacuation on the physiopathology of the critically burned patient based on the experience on 63 patients evacuated by air. Clinical repercussions are due to accelerations, vibrations, noise, and, primarily, to altitude. Accelerations are important during take-off and landing, and vibrations may be important in helicopter evacuations in the presence of craniofacial trauma. The noise, especially in helicopters, can interfere with diagnostic and therapeutic maneuvers in-flight. The altitude modifies atmospheric pressure, partial pressure of oxygen, and water concentration in inhaled air. In the aircraft we use, atmospheric pressure is between 550 and 532 mm Hg at the normal flight altitudes. This situation determines the expansion of body gases. Hypoxia seriously worsens any respiratory insufficiency, primarily in the presence of smoke inhalation. The decrease of water concentration in the inhaled air compels the increase of fluid perfusion. Pre-flight and in-flight measures are analyzed, especially with regard to smoke inhalation, pneumothorax, and parenteral perfusion.