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What happens when you are the doctor on the airplane?

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Re: What happens when you are the doctor on the airplane?

#101

Post by ColinDabritz »

FireBeyond wrote: post #86
omegant wrote: post #22

I have had several medical emergencies onboard as a pilot. One thing I constantly say to physician friends (my wife is a doctor), is that we (the crew) expect from them to make as fast assessment of the situation as possible. For example in my company we don´t have an online doctor to ask for help, so the volunteer has to take care of the situation. Recognizing the problem as soon as possible and prescribing the nece…

"Ask for the medikit (only physicians are allowed to use it)"? Are you sure? As a paramedic, I know of several cases where it's been used by paramedics and even EMTs. In fact, realistically (though not for a moment to denigrate physician knowledge, and training, etc), arguably most of the equipment in a commercial airplane medikit is -more- familiar to a paramedic than a family practitioner or indeed any physician wh…

Perhaps it was imprecise language, I would use 'physician' more broadly. I imagine he means "trained medical personel" e.g. and not the untrained flight staff.

Re: What happens when you are the doctor on the airplane?

#102

Post by FireBeyond »

JshWright wrote: post #91
FireBeyond wrote: post #81

Earlier quoted context omitted.

As an opioid in rapid sequence induction, potentially used for tracheal intubation.

Opioids are rarely in RSI. RSI uses a sedative and a paralytic. The sedative is almost always a benzodiazapine, and occasionally a dissociative or hypnotic sedative like ketamine or etomidate. Morphine would be a _very_ poor choice for a sedative in an RSI protocol.

Actually, no idea why I grabbed onto morphine in that discussion.

Our protocols call for vecuronium, atropine, etomidate, succinylcholine. However, we do also use fentanyl if indicated to deal with tachycardia and ICP.

One other thing I noted in the original article was bemoaning the lack of pulse oximetry, "to assess if patient was exchanging oxygen". Treat the patient, not the number. If your patient is in respiratory distress but has 100% SpO2, treat the distress. If your patient appears /comfortable/ and /normal/ at 90%, go with what seems appropriate to their case.

(In fact, our MPD excludes Pulse Oximetry and Blood Glucose from BLS protocols on the grounds of 'treat the patient' - though my opinion tends to differ on the latter).

Re: What happens when you are the doctor on the airplane?

#103

Post by JshWright »

_wesley_ wrote: post #94

This was a very interesting article, given that I just experienced something similar. Flight from SFO -> IAD last week. As soon as we took off, they asked for a doctor. He spent 2 hours treating the patient before they started drink service, and continued until we landed. We were all quite worried about the person, but found out at the end of the flight that they had overdosed on NyQuil. That made the whole ordeal fa…

Overdosed on NyQuil? How much NyQuil did he take?

I have no idea how big a typical bottle of NyQuil is, but assuming it's somewhere in the ballpark of 10oz (we'll call it 300ml to make the math easy). NyQuil has 325mg/15ml, so our hypothetical 10oz bottle has ~6,500mg in it. That's certainly a respectable dose of Tylenol, but it's not likely to be fatal in a couple hours for an average sized adult...

Re: What happens when you are the doctor on the airplane?

#104

Post by jlgreco »

supwiggles wrote: post #39
niekmaas wrote: post #38

Earlier quoted context omitted.

Out of hospital CPR has very slim survival chances. Being on a plane will result in at least 30 minutes of CPR even before an ambulance can take over. Chances on surviving that are extremely low. Therefore I can see why the doctor on the plane decided not to perform CPR. I have a medical degree myself btw.

This +10. Out of the 11 out of hospital arrests that I went to as a Paramedic (in a 6 month period), only 1 of them survived. Ironically, the one who survived was a prisoner who had cut his own throat. He had pretty much bled out by the time we got there, with a tiny little junctional on the monitor. Today he has 0 deficits, and it is like the event never occurred.

Is CPR done on people with wounds like that? I would think the chest compressions would mostly just be pushing blood out, but I guess doing that is better than doing nothing?

Re: What happens when you are the doctor on the airplane?

#105

Post by michaelhoffman »

maaku wrote: post #54
omegant wrote: post #22

I have had several medical emergencies onboard as a pilot. One thing I constantly say to physician friends (my wife is a doctor), is that we (the crew) expect from them to make as fast assessment of the situation as possible. For example in my company we don´t have an online doctor to ask for help, so the volunteer has to take care of the situation. Recognizing the problem as soon as possible and prescribing the nece…

I know I'm going to get down-voted for an information-free post, but I think it's awesome that you're a commercial pilot and participating in HN. It can sometimes get too insular with valley-type techies here. Thanks for participating.

Not for being "information-free" but for breaking the guidelines: "Please don't bait other users by inviting them to downmod you."

Re: What happens when you are the doctor on the airplane?

#106

Post by thematt »

supwiggles wrote: post #39
niekmaas wrote: post #38

Earlier quoted context omitted.

Out of hospital CPR has very slim survival chances. Being on a plane will result in at least 30 minutes of CPR even before an ambulance can take over. Chances on surviving that are extremely low. Therefore I can see why the doctor on the plane decided not to perform CPR. I have a medical degree myself btw.

This +10. Out of the 11 out of hospital arrests that I went to as a Paramedic (in a 6 month period), only 1 of them survived. Ironically, the one who survived was a prisoner who had cut his own throat. He had pretty much bled out by the time we got there, with a tiny little junctional on the monitor. Today he has 0 deficits, and it is like the event never occurred.

Maybe I'm missing something, but even if there's only a 10% chance of survival I'd still want somebody to give it a shot. What is the downside -- somebody has to do it for 30 minutes until the plane lands?

Re: What happens when you are the doctor on the airplane?

#107

Post by cstross »

joezydeco wrote: post #35
pavel_lishin wrote: post #30

Earlier quoted context omitted.

Why would a diabetic person not travel with insulin?

Pretty much a collision of unfortunate events. We were at a work function until 2am in London and returned to our room to find it had been robbed. The thieves took his bag which contained his insulin kit. So now it's 3am GMT and he can't reach his doctor in the States. We're supposed to leave at 8am for the flight home. No pharmacy is open and even if they were, they wouldn't help him. Nurses at Heathrow couldn't hel…

Actually, IIRC insulin is classified as a Pharmacy-Only medicine in the UK, rather than Prescription-Only, meaning that it can be sold by a pharmacist without requiring a prescription, to address exactly this sort of situation.

Even if they've reclassified it as a POM in the 25 years since I stopped doing that stuff for a living, if you could have found a pharmacy in the UK, then under the Emergency Sale and Supply regs the pharmacist could, on their own recognizance, dispense a sufficient supply of prescription-only meds to get the patient back home.

(Caveat: I am an ex-pharmacist. Any advice I could conceivably give you is over two decades past its sell-by date and needs checking.)

Edit Current emergency sale and supply regs are described here:

http://www.nhs.uk/chq/Pages/1011.aspx?CategoryID=73&SubC...

Re: What happens when you are the doctor on the airplane?

#108

Post by davidw »

omegant wrote: post #22

I have had several medical emergencies onboard as a pilot. One thing I constantly say to physician friends (my wife is a doctor), is that we (the crew) expect from them to make as fast assessment of the situation as possible. For example in my company we don´t have an online doctor to ask for help, so the volunteer has to take care of the situation. Recognizing the problem as soon as possible and prescribing the nece…

> never declare a decease onboard

I had a friend on a transatlantic flight that got stuck in Iceland (they tried to get the person on the ground and to a hospital but there wasn't really anything that could be done) for... a long time... because of this. And IIRC, letting them off the plane was not really an option either, so it ended up being not only depressing, but pretty miserable in other ways as well.

Re: What happens when you are the doctor on the airplane?

#109

Post by Tichy »

Dove wrote: post #51

My dad, an electrical engineer, was once on his way back from a conference with a Concorde flight full of other EEs. In the air, the stewardess asked, "Is there an engineer on board?" Everyone responded enthusiastically. She was forced to clarify, "Is there an aeronautical engineer on board," to disappointment all around. I must admit, some secret part of me always hopes I'll be in a situation on an airplane where th…

Something like this: http://www.martinsteiger.aero/files/flightforum_ch/2008/fern... :-)

Re: What happens when you are the doctor on the airplane?

#110

Post by carbocation »

JshWright wrote: post #46
joezydeco wrote: post #21

I'm curious if insulin is a standard part of the medkit. I was on a transatlantic crossing once with a coworker who went into diabetic shock (that's another long story). A nurse was onboard the flight but no insulin. We had to divert and my coworker was laid up in a Newfoundland hospital for 3 days.

Insulin isn't something you need acutely. Insulin is used to treat _hyper_glycemia (blood sugar too high). This is a gradually developing condition, and someone couldn't go from 'normal' to 'critically ill' over the course of a flight. EDIT: reading your description below regarding the stolen meds, this seems reasonable. He likely _was_ experiencing some symptoms of hyperglycemia even as you were boarding. The most c…

Don't forget the two big hyperglycemic emergencies: diabetic ketoacidosis and hyperosmolar hyperglycemic state.
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