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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?

#121

Post by miles_matthias »

carbocation wrote: post #111
miles_matthias wrote: post #31

Okay, I'll share random doctor flight story - last week some family friends were flying to Hawaii for vacation, and a man across the isle said he had been on vacation for several weeks and didn't bring enough heart medicine. He said he would just get some more when he got home, but halfway through the flight he slumped down in his chair, unresponsive. There was a doctor on the flight that used a stethoscope to find t…

He absolutely deserved to have an AED hooked up to him, and CPR in the time it took to hook up the AED. If he was pulseless because of, say, Vfib, the AED could very well have saved his life. If he had pulseless electrical activity, then there is an algorithm for that, too. Some would say that you aren't dead with PEA until you've got a needle in the second intercostal spaces bilaterally and one penetrating the peric…

Do they have AEDs on planes?

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

#122

Post by cwb71 »

FireBeyond wrote: post #102
JshWright wrote: post #91

Earlier quoted context omitted.

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 respirat…

Reading between the lines just a little bit, I got the feeling based on the doc's description of his patient's behavior earlier in the flight that he suspected she was just being a drama queen and that this was more of a "psychiatric issue." Perhaps he wanted to test that hypothesis?

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

#123

Post by walshemj »

ibejoeb wrote: post #97
stephencanon wrote: post #34

My wife is a surgeon; while we were flying to Morocco last spring, a man on the plane accidentally put himself into a diabetic coma. A nurse was sitting next to him and thought that he was having a heart attack. The attendants called for a doctor; my wife recognized the actual issue, and revived him by rubbing honey on the inside of his mouth and gums (the onboard medical kit had nothing of use beyond rubber gloves).…

Wow, shocking that the plane did not have glucose tablets. I carry the gel in my luggage just in case since it's particularly common and so simple. I guess sugar is sugar, but manipulating gooey honey sounds a lot harder that squirting gel pack. (Don't want to rant too much, but it irks me that TSA has, once or twice, confronted me on the things.)

yes back when I helped organize a medium sized (1200-11300) camping event we always had plenty of sugar and mars bars to cater for diabetics that went out of balance this is in addition to what the on site St Johns team had.

Only had one close shave where some one diabetic had become and unconscious and thrown up in there sleeping bag - let me tell you seeing someone being carried towards you on a stretcher certainly gets rid of the hangover quick - this was pre mobile phones so i had to sprint to the public call box to call 999 (911)

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

#124

Post by carbocation »

miles_matthias wrote: post #121
carbocation wrote: post #111

Earlier quoted context omitted.

He absolutely deserved to have an AED hooked up to him, and CPR in the time it took to hook up the AED. If he was pulseless because of, say, Vfib, the AED could very well have saved his life. If he had pulseless electrical activity, then there is an algorithm for that, too. Some would say that you aren't dead with PEA until you've got a needle in the second intercostal spaces bilaterally and one penetrating the peric…

Do they have AEDs on planes?

According to the article and to other discussants, yes, AEDs are provided on planes. I haven't personally seen the medical loadout on a plane.

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

#125

Post by cperciva »

carbocation wrote: post #110
JshWright wrote: post #46

Earlier quoted context omitted.

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.

I'd still say that the most important thing there is to give fluids, not insulin. When you're seeing a new patient and don't have a medical history, it's impossible to know how sensitive they will be to insulin, and the last thing you want to do on a transatlantic flight is take them from hyperglycaemic to hypoglycaemic. Giving enough fluids will allow the kidneys to do most of the the critical fixing of blood chemistry.

(I am not a doctor, but I am a diabetic who has experienced DKA.)

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

#126

Post by carbocation »

cperciva wrote: post #125
carbocation wrote: post #110

Earlier quoted context omitted.

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

I'd still say that the most important thing there is to give fluids, not insulin. When you're seeing a new patient and don't have a medical history, it's impossible to know how sensitive they will be to insulin, and the last thing you want to do on a transatlantic flight is take them from hyperglycaemic to hypoglycaemic. Giving enough fluids will allow the kidneys to do most of the the critical fixing of blood chemis…

Yes, I agree that one critical element of treatment is fluid resuscitation. I think that because the person who started this thread was talking about insulin, that has remained a subtext throughout the conversation. My goal in posting was to alert people to the fact that blood insulin/glucose emergencies include states on both extremes of the insulin/glucose spectrum. I didn't mean to imply anything about management.

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

#127

Post by rdl »

cstross wrote: post #107
joezydeco wrote: post #35

Earlier quoted context omitted.

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 r…

What is your favorite sci-fi story involving a pharmacist?

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

#128

Post by rdl »

jlgreco wrote: post #104
supwiggles wrote: post #39

Earlier quoted context omitted.

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?

The new protocol (at least for military, or at least serious trauma) is to treat massive bleeding above airway/breathing/circulation. I guess what you'd do is have someone applying pressure (or strap an israeli bandage around the neck, but not tightly in a way which would cut off circulation?) while someone else does CPR and then AED. The goal is to never have more than a 10sec break in chest compressions.

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

#129

Post by cperciva »

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…

I must admit, some secret part of me always hopes I'll be in a situation on an airplane where they need an emergency perl script written

On a flight from Sydney to Vancouver earlier this year, the in-flight entertainment system on my plane was broken. I spoke up: "Hi, I have a doctorate in computer science and I know a bit about these systems... want me to take a look?"

I was surprised when they agreed, brought me up to the front galley, and showed me their interface to the entertainment system (alas, the server itself was in the ceiling and not accessible). I ended up pulling out my laptop, borrowing a cat5 cable from one of the flight attendants (all of mine were in my checked suitcase) and running tcpdump on the plane's network. Alas, while that allowed me to diagnose the problem, I lacked the serial cable needed to connect to the server's console and wasn't able to fix it.

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

#130

Post by mkuhn »

georgemcbay wrote: post #88
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…

"Is there an aeronautical engineer on board," One of the top 5 questions you don't want to hear over the loudspeaker while flying on a supersonic jet.

Now I am intrigued and want to hear the other four.
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