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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?

#171

Post by JshWright »

lambda wrote: post #149
ilamont wrote: post #14

Earlier quoted context omitted.

The stricken passenger had the option of using the restroom, but for unknown reasons could not urinate. They stretched him out on a row of seats which seemed to help the pain, but from what I recall was unable to go until they reached the destination airport. The total trip time was about three hours.

Huh. According to the article that you linked to about the coat hanger, brandy, and rubber tube: 'The aircraft's medical kit is "quite well-equipped for having babies and people who develop urinary blockages..."'. In fact, it sounds like the tube they used to drain the lung was a catheter intended for urinary blockage. I wonder why they couldn't use such a catheter for this guy; did that kit not have one?

If it progressed to the point of a true medical emergency, I suspect the kit at least had the equipment necessary for a 'quick and dirty' suprapubic aspiration of the bladder (stick a longish needle in from the front, and use a syringe to pull fluid out).

Generally speaking, this is done with an ultrasound, but in a pinch, you could likely just palpate the bladder.

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

#172

Post by eric_bullington »

FireBeyond wrote: post #87
niels_olson wrote: post #64

Earlier quoted context omitted.

I believe this document has the current ICAO med kit. Interestingly, I work with the guys who draw up these supply lists for naval ships, and we're chopping one now. Will definitely include this in the discussion. I really hope you can send me your company list. http://www.asma.org/asma/media/asma/pdf-policy/2007/airline-...

Interesting - this is essentially an ALS (Advanced Life Support / Paramedic) bag.

Minus a laryngoscope and other vital airway kit items. Although I couldn't imagine trying to use one on the aisle of an aircraft, I'm sure there are many paramedics, anesthesiologists, and ER nurses and physicians who wouldn't hesitate if one were needed. All there appears to be for airway support are oropharyngeal airways. That's surprising and in my opinion (as someone with long-expired EMT training), unfortunate. The same goes for AEDs. A $2000 kit that could save someone's live from being claimed from the most common group of disease in the Western world (cardiovascular diseases) should be a no-brainer aboard a 200 million dollar aircraft. People are helpless at 30,000 feet and it's the airlines' responsibility to have the equipment available for qualified medical professionals who happen to be on board in the event of an emergency. AEDs could even be used by steward/esses who had undergone minimal training.

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

#173

Post by JshWright »

thematt wrote: post #106
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.

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?

That's 10% for someone who had access to advanced care within a few minutes.

If CPR goes on for more than 10 minutes or so in a non-hypothermic patient (with no other interventions), your chances of survival are basically nil. This is is especially true if you have a limited number of people doing compressions. Effective compressions are extremely hard work, and rescuer fatigue is a huge issue with CPR (we switch every two minutes no matter how 'fine' the person doing compressions claims to be). I doubt you could maintain effective CPR on an aircraft for 30 minutes (I suppose you could get a couple dozen people involved, but that seems unlikely).

If I'm not back in 15 minutes, please stop... At that point enough damage has been done to my brain that I don't want to come back...

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

#174

Post by lotharbot »

protomyth wrote: post #170
lotharbot wrote: post #159

Earlier quoted context omitted.

That said, pilots -- or even non-pilots -- can actually do fairly well landing a large aircraft as long as they're being talked through the process by someone experienced. See http://mythbustersresults.com/episode94

I really wouldn't consider MythBusters a good source. The test they came up with for the snow plow episode is so far from a proper model, it gave exactly the wrong results and basically told folks something wrong and dangerous. It is fun entertainment and they try hard within those bounds, but they get stuff totally wrong sometimes.

Sometimes their tests are terrible. This is not one of those times.

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

#176

Post by JshWright »

eric_bullington wrote: post #172
FireBeyond wrote: post #87

Earlier quoted context omitted.

Interesting - this is essentially an ALS (Advanced Life Support / Paramedic) bag.

Minus a laryngoscope and other vital airway kit items. Although I couldn't imagine trying to use one on the aisle of an aircraft, I'm sure there are many paramedics, anesthesiologists, and ER nurses and physicians who wouldn't hesitate if one were needed. All there appears to be for airway support are oropharyngeal airways. That's surprising and in my opinion (as someone with long-expired EMT training), unfortunate.…

The aisle of an airplane would be an awesome place to intubate someone. One of my favorite intubation positions is having the patient lying supine, then lying prone 'above' them. This obviously only works of you have a fair amount of space in at least one direction (like an airplane aisle).

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

#177

Post by jychang »

loceng wrote: post #77
omegant wrote: post #68

Earlier quoted context omitted.

Well I am also founding my own startup..;) so maybe it doesn't count!

I wish there was a better way on HN to know someone's other disciplines. They're usually hidden out of context.

I like reddit's Askscience's method of having a short tag next to the username. This could be helpful.

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

#178

Post by spc476 »

protomyth wrote: post #170
lotharbot wrote: post #159

Earlier quoted context omitted.

That said, pilots -- or even non-pilots -- can actually do fairly well landing a large aircraft as long as they're being talked through the process by someone experienced. See http://mythbustersresults.com/episode94

I really wouldn't consider MythBusters a good source. The test they came up with for the snow plow episode is so far from a proper model, it gave exactly the wrong results and basically told folks something wrong and dangerous. It is fun entertainment and they try hard within those bounds, but they get stuff totally wrong sometimes.

I had the chance to land an Airbus 320 (simulator) several years ago. Yes, with instruction, I found it easier to land the plane than in Microsoft's Flight Simulator (http://boston.conman.org/2007/12/28.2).

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

#179

Post by dlgeek »

carbocation wrote: post #124
miles_matthias wrote: post #121

Earlier quoted context omitted.

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.

Every plane I've flown on has an AED symbol or mention of AED (as well as medical kit) marked in one of the reserved overhead bins near the front of the plane - I'm pretty sure they're standard issue on every commercial airliner.

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

#180

Post by [deleted] »

JshWright wrote: post #16

The medical director of my paramedic program used to work for a hospital that provided medical control for a number of major airlines (generally speaking, even when they ask for a physician on a plane, they're also calling the airline's 'on call' doctor as well). His scariest stories weren't due to the criticality of the patient, but rather the incompetence of the provider on board the plane (to the point that he, on…

[deleted]
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