Page 39 - 2026 SMOG

DECOMPRESSION SICKNESS
• Definitive treatment is to bring the patient to a HYPERbaric chamber
˚ Contact a flight surgeon for coordination
˚ Transport patient to the closest HYPERbaric chamber; lowest possible profile flight
(below 1,000ft)
Notes, Cautions, Warnings
• Onset can occur as long as 48 hours after exposure to altitudes above 18,000 ft.
• Denitrogenation (nitrogen concentration is reduced by breathing 100% O . This allows no new
2
nitrogen into the body while existing nitrogen is removed from the lungs, eliminating much of
the nitrogen dissolved in body tissues.)
• Treat all types of DCS as an emergency.

DENTAL PROBLEMS
Signs/Symptoms Differential Diagnosis
• Bleeding • Dental Caries
• Fever • Infection
• Pain • Fracture
• Swelling • Avulsion
• Missing/fractured tooth • Abscess/cellulitis
• Gingivitis
• TACTICAL EVACUATION PROTOCOL
• UNIVERSAL PATIENT CARE PROTOCOL
• Control Bleeding
• Tooth Avulsion
˚ If <1hr, attempt to replace tooth in socket (**See Notes, Cautions, Warnings**)
Place tooth in NS (milk, if available)
˚
• PAIN MANAGEMENT PROTOCOL
Notes, Cautions, Warnings
• Significant soft tissue swelling of the face/mouth can represent cellulitis or an abscess.
• Avulsion (complete avulsion only)
˚ Gently rinse (do not scrub) the tooth with NS and attempt to reimplant with firm pressure into the
socket. Never perform this on children with primary teeth.
˚ As able and without obstructing the airway, place a bulky dressing over the tooth and use it as a
soft bite block to stabilize the tooth. Instruct to bite down gently; do not move the jaw.
• Subluxation (tooth displaced in socket)
˚ Treatment is not always required
˚ For obviously loose or displaced teeth, consider placing a bulky dressing over the tooth and using
it as a soft bite block to stabilize the tooth. Instruct to bite down gently; do not move the jaw.
• Occasionally, cardiac chest pain can radiate to the jaw
• Patients with a dental abscess may experience significant pain at altitude due to gas volume expansion
at lower atmospheric pressure. Consider flying at a lower altitude and refer to the
PAIN MANAGEMENT PROTOCOL.

2026 Standard Medical Operating Guidelines (SMOG) • 31