Efforts must be made to eliminate gas in the intestines prior to flight. Carbonated beverages, chewing gum, large meals, and pre-existing gastrointestinal disease can all lead to air in the stomach which can expand on ascent. This may lead not only to abdominal discomfort, but also to nausea, vomiting, shortness of breath, and hyperventilation. Distension of the abdominal contents may result in venous pooling, leading to syncope with subsequent tachycardia and hypotension. Thus patients with bowel obstruction or recent abdominal surgery must have a patent and unclamped nasal or oral gastric tube placed prior to transport. High-altitude fixed-wing transport in the early postoperative period is not without risk due to ileus and gas formation, leading to aspiration.
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