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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?

#111

Post by carbocation »

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 pericardium.

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

#112

Post by carbocation »

ubernostrum wrote: post #43
e40 wrote: post #37

Earlier quoted context omitted.

It's a little surprising to me they didn't even attempt CPR.

Remember that CPR will not restart a stopped heart. CPR's only use is to maintain some blood/air flow until you can get to a defibrillator or life-support machinery, in hopes of preventing damage to the brain or other vital bits. And unless it's started pretty much immediately , it won't even accomplish that, which makes it futile.

This type of situation is exactly the reason AEDs are now found all over in public places. Sure, CPR for several hours does not yield positive outcomes. But if this guy is slumped because of a shockable rhythm, that AED in the field is not at all useless - it will likely save his life, and minimize the deficits he experiences afterward. Especially on a plane, where the person was likely noticed down minutes after his problem started.

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

#113

Post by carbocation »

JshWright wrote: post #103
_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...

I'd guess that the problem was excessive sedation due to the antihistamine, rather than acute liver injury from acetaminophen toxicity.

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

#114

Post by JshWright »

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.

Sure, but DKA and HHNK aren't generally sudden onset sorts of things. Usually there's been a few hours worth of symptoms leading up to them.

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

#115

Post by JshWright »

logjam wrote: post #74

I was half-dozing on a Southwestern flight when a stewardess came on the PA system calling for any physician to identify themselves. I spoke up, and the crew directed me toward the back. They already had this incredible medical kit opened in the aisle. I mean they had everything ....ACLS drugs, defibrillator, suction, a complete mini-pharmacy, and what looked like a few plastic-7 wound and/or trauma kits at the least…

> they had everything....ACLS drugs, defibrillator, suction, a complete mini-pharmacy, and what looked like a few plastic-7 wound and/or trauma kits at the least.

That's very reassuring. Any intubation equipment (or at least airway adjuncts (LMA, King, etc))? BVM?

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

#116

Post by carbocation »

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.

Fentanyl is reasonably commonly used.

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

#117

Post by elechi »

stephencanon wrote: post #59
JshWright wrote: post #52

Earlier quoted context omitted.

I'm assuming the patient wasn't a racehorse? If I had a dollar for every time a dermatologist or podiatrist tried to be 'helpful' on an emergency scene... I could probably buy a coffee at Starbucks... The same goes for 'nurses.' If an ER nurse wants to help out, that's great. Invariably though, it's a nurse at a nursing home or dialysis center... I don't mean to imply these folks aren't skilled professionals, but pre…

Unlike a podiatrist, a dermatologist went to medical school. If they're young, there's actually a good chance that they were among the very best medical students -- in the past few years, dermatology has become one of the more competitive fields in medicine because of the lifestyle (short predictable hours, high pay, minimal insurance hassles). There are daft people in every field, but I would be delighted to have mo…

I can't tell if you're joking or not, but a podiatrist does have to go to medical school.

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

#118

Post by carbocation »

JshWright wrote: post #114
carbocation wrote: post #110

Earlier quoted context omitted.

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

Sure, but DKA and HHNK aren't generally sudden onset sorts of things. Usually there's been a few hours worth of symptoms leading up to them.

From joezydeco's follow-up comment from a few hours ago, it sounds like there was a window of concern for several hours before boarding the flight. At any rate, there was no mention of this being sudden onset. Just encouraging people on this site who don't have a medical background to understand that there are indeed emergencies due to hyperglycemia/hypoinsulinemia.

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

#119

Post by walshemj »

logjam wrote: post #74

I was half-dozing on a Southwestern flight when a stewardess came on the PA system calling for any physician to identify themselves. I spoke up, and the crew directed me toward the back. They already had this incredible medical kit opened in the aisle. I mean they had everything ....ACLS drugs, defibrillator, suction, a complete mini-pharmacy, and what looked like a few plastic-7 wound and/or trauma kits at the least…

Would not they check the passenger list for Dr's first? I remember being told that this was an occupational hazard for Phd's that you might be assumed to be a MD Dr.

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

#120

Post by bostonpete »

michaelhoffman wrote: post #105
maaku wrote: post #54

Earlier quoted context omitted.

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."

I don't think he was baiting users so much as apologizing in advance.
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