Monday, October 13, 2008

Treating a patient on a plane

While on a plane from Calgary to Phoenix with my Family yesterday, the stewards asked for medical personnel for help.

A 74 year old female complained of nausea, light-headedness and shortness of breath. The Stewardesses had already appropriately given her oxygen, but she did not improve.

On assessment, I discovered that the patient's pulse was weak and thready and that her heart rate was regular, but zipping along somewhere close to 200! Her pressure was normal and she was otherwise well with no comorbidities or cardiac history.

It was apparent that this lady was in PSVT and getting increasingly anxious and not maintaining pressure. After listening to her neck, I decided to do a rather firm carotid sinus massage while having the poor lady (a retired trauma nurse) valsalva (bear down) at the same time (There didn't appear to be any bruit (turbulence) in her carotids).

Thankfully, she converted right away....and this lasted about 10 minutes until her next the valsalva was repeated again with some success (and ice water).....and seemed to stabilize after the 3rd "conversion".

The captain asked me a couple of times whether or not he needed to divert the plane....but she seemed stable and had calmed down. A diversion would only have made about a 15-20 min difference in any case.

A peds ICU nurse that helped along opened the "medical pouch" on the plane, and it appeared that all there was, was ASA, Tylenol and some old Sublingual nitro tabs. I gave the ASA as a precaution (no allergies or asthma), and held back on the nitro (no chest pain or variant angina)

I wanted to keep her calm and relaxed, so we had a nice long chat while doing breathing exercises for an hour or so - and learned that she was the widow of a fighter pilot, she snowbirded in Phoenix, had 2 daughters (one in Philly where she was en route and one that was a Pediatrician in Calgary) was very interesting to learn about her life experiences and her travels throughout the world and the wars with her fighter pilot fact, listening to her about her life was more interesting than any novel or in flight movie I could have busied myself with!

Eventually, the firemen arrived and I filled them I on a synopsis of "successfully converted PSVT in probable need of a long-term beta blocker".....but they didn't seem that interested in the details (the Medics were waiting off the plane).....their job was to assess and manage overall risk.

I then returned to my seat amidst some kind but rather embarrassing applause from the other passengers.

The whole experience - although far from a serene and relaxing flight, was overall a positive experience for me....I'm not sure why there are grumblings in the odd newspaper stories about Dr.'s on flights being "forced to work" when called upon on airline flights.

The fact is, that being a Doctor is a rare and special privilege. Should we be expected to always help out in an urgent situation? Absolutely......but to do so at a personal or professional cost should not be assumed by the airline or cruise industry.

A Physician's urgent actions on an airplane or other similar situation (I once put a chest tube in an old man with a pneumothorax on a cruise ship) is ONLY between the Physician and the person/people that they treat. Cruise ships and Airlines are external to that relationship......although one would think that a note or acknowledgment of appreciation from the airline or cruise ship would just be good form.....

ps.  the stethoscopes, blood pressure cuffs and meds kits they carry on airplanes are woefully outdated, and inadequate of quality or quantity.  They really should address this.  From now on, I'm going to carry my own equipment and emergency meds!



pilot said...

Well done! The medical kits at Air Canada were designed in conjunction with medical consultants. If it's out of date perhaps someone needs to contact the airline? (I don't know about other airlines). I also know that the AC kit includes a legal release form for the doctor to limit his/her liability. Not sure about the Thank You cards, but that would be a nice touch.

Again, well done.

Anonymous said...

You, my friend, are the real deal.

Ed Sodaro MD

Callsign Echo said...

That was a great story. Your attitude is really admirable. Most pilots feel that flying is a blessing and a priviledge; it's great to hear someone from another field with the same passion for what they do.

Christopher said...

Thank you for the excellent description of your experience.

I wonder if you would be willing to indicate if this was a Canadian or American airline? The equipment requirements are slightly different between the two countries.

In Canada, emergency medical kits are only required to be carried on board aircraft with 100 or more passengers and should have these minimum contents. All aircraft will have a first aid kit with these contents.

Here are also a few articles that were written a few years ago that you may also find interesting:

On a wing and a prayer: medical emergencies on board commercial aircraft

Winging It! The Prevention and Management of In-flight Emergencies

John Fernandes MD said...

Thanks for your comment. To answer your question, the flight was with US Airways.

Anonymous said...

Nice post; GREAT attitude. I hope that you or someone like you is around if a loved one or member of my family needs your services and cannot get to a medical facility quickly enough.

Thanks, Doc. Sincerely.

phil said...

very cool.