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Balanced transfusion (1:1:1 ratio of PRBCs, plasma, and platelets) restores oxygen-carrying capacity and coagulation factors while limiting dilution. Excess crystalloids worsen acidosis and coagulopathy. Hypertonic saline and albumin are not first-line in major trauma. Flight crews must carry blood products when possible, titrate to permissive hypotension, and notify trauma centers early for massive transfusion protocols.

The Parkland formula guides initial burn resuscitation: 4 mL × kg × %TBSA burned, with half given in the first 8 hours, remainder in 16 hours. Rule of Nines estimates TBSA in adults, not pediatrics (Lund-Browder chart preferred in children). Holliday-Segar calculates maintenance fluids, not resuscitation. Maintenance alone is inadequate in major burns. Air crews must calculate and titrate fluids carefully, monitor urine output, and prepare for rapid deterioration.

Amiodarone stabilizes myocardium and reduces recurrence of VT, decreasing ICD shocks. Deactivating the ICD without alternate defibrillation is unsafe. Ignoring shocks neglects patient distress and ongoing arrhythmia. Digoxin is not appropriate for VT suppression and may worsen arrhythmias. Flight crews should secure IV access, give 150 mg amiodarone bolus followed by infusion, and prepare for external defibrillation if ICD fails. Coordination with cardiology at destination ensures device interrogation and further management.

In ischemic stroke patients not receiving tPA, permissive hypertension is allowed up to SBP 220 and DBP 120 to maintain cerebral perfusion. Aggressive lowering can worsen ischemia. If thrombolysis is used, BP must be ≤180/105. Crews should monitor closely but avoid unnecessary antihypertensive treatment en route unless above thresholds or with complicating conditions (e.g., aortic dissection, heart failure). This strategy balances perfusion needs against risk of hemorrhagic conversion.

Severe hypothermia depresses cardiac conduction and renders drugs/pacing less effective until core temperature rises. Rewarming—active external and internal methods—is the mainstay. Bradycardia at this temperature is physiologic. Atropine and pacing are ineffective and may precipitate arrhythmias. Epinephrine may be given in cardiac arrest but is not primary therapy here. Stabilization includes gentle handling, warmed fluids, forced-air warming, and minimizing patient movement to avoid arrhythmia. Rewarming resolves bradycardia naturally.