Key messages

• The transport of critically ill patients always involves some risk.

• The appropriate transport modality (ground versus air) and appropriate team composition are central to successful transport.

• Special considerations of altitude come into play when patients are transported by aircraft.

• Dalton's, Boyle's, and Charles' laws reveal that hypoxia occurs at altitude, gas expands at altitude, and gas expands as the temperature rises.

• Hypoxia, hypemia, and stagnant or histotoxic hypoxia can occur at altitude.

• Tachycardia occurs early with increase in altitude.

• Central nervous system signs are seen with altitude-induced hypoxia.

• Gas expands in the gastrointestinal tract and may lead to aspiration if gastric decompression is not performed.

• Barotitis media and barosinusitis should preclude crew from flying.

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