AEROMEDICAL

EVACUATION PLAN
RECOMMENDATION
PRESENTED BY: NANDA MARDAS
S.
Case Illusration

Mr. I 70 y.o with a shortness of breath • VITAL SIGN

accompanied by chest pain 2 weeks prior of • Blood Pressure : 150/90 mmHg
hospital admission • Heart Rate : 91 x/min
• Respiratory Rate : 24 x/min
a month ago patient was admitted to hospital
• Temperature : 36oC
with a major complain of lower extremity • Consciousness : Full Alert
edema • VAS :4
Patient has a history of Diabetes Mellitus • Anthropometric
• Body Weight : 70 kg
• Body Height : 170 kg
• Physical Examination
• Eye : Anemic Conjungtiva +/+
• Heart : normal Heart sound M(-)
G(-)
• Lung : Vesiculer +/+ Coarse
Ronchi +/+
Wheezing -/-
• Extremity : Pitting Edema in lower
Extremity
• SaO2 : 80 %
Test Result Reference Test Result Reference Test Result Reference
Value Value Value

Hematology Electrolyte Cardiac Biomarker

LED - ♀: ≤ 20 K+ 3.1 3.5-5.0 Troponin 0.06 0.01 ng/ml
♂ : ≤ 10 mmoL/L
I
Hb 11.6 ♀: 12 – 14 g/dL Na+ 145 136-146 mmoL/L
♂ : ≤ 13 – 16 Hemostasis
g/dL Cl -
102 98-106 PT  11 - 15
mmoL/L 15.7
Leukocyte 8750 5000 – 10.000
Control PT
/uL
Kidney Function Test 13.4
Erythrocyte - ♀: 4.0 – 5.0 APTT 24.1 27 - 37
♂ : 4.5 – 5.5
Creatinin 1.1 ♀: < 1.2
mg/dL Control 32.6
Hematocrit 36 ♀: 37 – 43 %
♂ : 40 – 48 %
♂ : < 1.3 APTT
mg/dL
Thrombocytes 213.00 150.000 –
400.000 Ureum 31 < 50
0
mg/dL
Lipid Profile Uric Acid 12.7 ♂ : ≤ 7 ; ♀ : ≤ 5.7
mg/dL
Total  < 200 mg/dL
182
Cholesterol Liver Function Test
HDL > 40 mg/dL
- SGPT 151 ♀: < 36 U/l
LDL - < 100 mg/dL ♂ : < 46 U/l
Trigliserid
122
< 150 mg/dL SGOT 255 ♀: < 27 U/l
♂ : < 33 U/l
Blood Sugar Profile Protein Profile
FBS - 70 – 110 Total Protein 6.1 6.6-8.7 gr/dL
mg/dL
Albumin 3.1 3.8-5.1
2HPP - 70 – 140
• Heart Enlargement, Elongated Aorta
• Increased Bronchovascular Markings with the appearance of
Hillar Haze
• Normal Costophrenic Angle, Normal Diapraghm
• Normal Thorax Skeletal Structure

• Cardiomegaly, Elongated Aorta and Pulmonary Edema

 Rhythm : Sinus Rhythm
Heart Rate : 107 beats/min
P waves : 0.08 sec, 0.2 mv
PR int : 0.20 sec
QRS complex : 0.08 sec
Axis : normoaxis
ST elevation at lead V3 V4
• Medication
• Valsartan 2x 80 mg
• Clopidogrel 4 x 75 mg
• ASA 2 x 80 mg
• Furosemid Infusion 3 mg/hour
• Isosorbide dinitrate Sublingual 5 mg
• Isosorbide dinitrate infusion 0.25
mg/hour
• Spironolactone 1 x 25 mg
• Heparin Infusion 700 ui/hour
• Curcuma Extract 3 x 1
• Sucralfate 3 x ½ teaspoon
• Gliquidone 2 x 30 mg
• Bisoprolol ½ - 0 – ½
• Tramset (Tramadol Paracetamol) 2 x
1
• Emibion 3 x 1

• Equipment
• Folley Catether
• NRM 10 l/m
• O2 sat
 Working Diagnosis

• STEMI anterior
• Diabetes Mellitus Type II Overweight
• Mild Anemia
• Gout

• Differential Diagnosis
• Congestive Heart Failure
• Acute Lung Edema
• Iron Deficiency Anemia
• Chronic Illness Anemia
• 46 Points
• High Risk, Judicious
use of anti-thrombotic
and invasive
therapies is prudent
in this high risk of
bleeding group

• 11.1% risk of in-

hospital major
bleeding
 EVAC PLAN

Singapore
(sin)

Jakarta
(cgk)
Estimated Flight Distance 558 miles (898 Estimated
km) with estimated duration about 1H atmospheric
50 mins using chartered fixed wing plane pressure (226 –
with normal cruise altitude fl 300 – 400 141 mmHg),
Aeromedical Concern
And Theoritical
Overview
 Aeromedical Disposition for
Air Evacuation or Repatriation
VERDICT

Patient now as the condition stated is considered unfit

for air medical evacuation or repatriation

Patient should be planned for further treatment to

stabilize the condition and assessment for the flying
fitness is deferred until the condition is stable and does
not warrant any further stabilization treatment
Low risk: age <65, first event, FLY AFTER 3
LOW RISK successful reperfusion, EF >45%, no DAYS
complications, no planned
investigations or interventions
Medium risk: EF >40%, no symptoms of FLY AFTER 10 DAYS
MEDIUM RISK heart failure, no evidence of inducible
ischaemia or arrhythmia, no planned
investigations or interventions
High risk: EF <40%, signs and symptoms DEFER TRAVEL
HIGH RISK of heart failure, those pending further UNTIL CONDITION
investigation, revascularisation or device STABLE
therapy