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Status epilepticus is defined as seizure ≥5 minutes. Lorazepam IV is the preferred first-line due to rapid onset and longer CNS activity compared to diazepam. If IV access is unavailable, IM midazolam is an option. Levetiracetam is effective but not rapid first-line for acute termination. Phenobarbital is second-line and slower. Air medical crews must stop seizures promptly to prevent hypoxia, acidosis, and neuronal injury. Secure airway, provide oxygen, monitor EtCO₂, and prepare for intubation if refractory or airway protection fails.

Hypothermia contributes to the “lethal triad” with acidosis and coagulopathy. Passive blankets alone are insufficient in cold or windy cabin environments. Warming IV fluids with approved devices and applying forced-air or chemical warming blankets before departure reduces core temperature loss. Cabin ventilation worsens heat loss. Delaying warming until arrival increases mortality. Proactive hypothermia prevention is critical in air medical trauma care.

The triad—hypotension, distended neck veins, and absent unilateral breath sounds—signals tension pneumothorax. Immediate needle decompression relieves intrathoracic pressure, restoring venous return and ventilation. In modern practice, preferred sites are the 4th–5th intercostal space anterior to mid-axillary line with an adequate-length catheter to traverse chest wall. Anterior 2nd ICS MCL is acceptable if anatomy/access dictates but may fail in large patients. Definitive chest tube placement should follow as soon as feasible. Intubation with increased PEEP can worsen tension. Delaying for ultrasound risks arrest. Trendelenburg provides no benefit and can impede ventilation. In air medical settings, ensure sharps safety, secure equipment against cabin motion, and continuously reassess for recurrence or contralateral tension, especially with positive-pressure ventilation.

Severe symptomatic bradycardia with instability requires immediate pacing. Atropine may be attempted but often fails in high-grade block or very low HR. Epinephrine infusion may support rate but pacing is faster and more reliable. Cardioversion is for tachyarrhythmias, not bradycardia. In flight, pacing pads must be secured firmly, communication made before delivering shocks, and sedation considered if patient is conscious. Rapid pacing prevents asystole and restores perfusion during transport.

Boyle’s Law: as pressure decreases, gas expands. Trapped bowel gas enlarges during ascent, worsening obstruction and pain, potentially causing perforation. Dalton’s Law affects oxygen partial pressure. Henry’s Law involves gas solubility in fluids. Charles’s Law involves volume/temperature relationship. Patients with bowel obstruction may require cabin altitude restriction or ground transport.