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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?

#91

Post by JshWright »

FireBeyond wrote: post #81
donretag wrote: post #25

"The medikit was actually really comprehensive ... that contained ... even morphine." I am surprised that it contained morphine. Pain killers would not help much in resolving whatever medical issue is occurring. Besides, is it not dangerous to report the fact that morphine is available on a flight? Some medkits are easily accessible and can be taken when the flight attendants are not looking.

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.

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

#92

Post by JshWright »

herdrick wrote: post #89
JshWright wrote: post #85

Earlier quoted context omitted.

How did you get the water into someone who was semi-concious?

Semi-conscious, if I recall correctly, covers a wide range of responsiveness. She was unable to stand and slow to respond to questions but was well-oriented w.r.t. person, place and time. Drinking water wasn't a problem. The possible danger is that they'll vomit it up after passing out, or that they have some issue that requires emergency surgery. Now you've put something in their stomach that they might vomit during…

No, the possible danger is that they'll aspirate the water and you'll compromise their airway. Sounds like she wasn't semi-concious though, just tired, and maybe a little lethargic.

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

#93

Post by FireBeyond »

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.

It won't, but there are several shockable rhythms that present as "pulseless" that can indeed be converted. AEDs will shock VF and VT, and manual defib can help with others.

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

#94

Post by _wesley_ »

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 fairly frustrating.

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

#95

Post by FireBeyond »

niekmaas wrote: post #38
e40 wrote: post #37

Earlier quoted context omitted.

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

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.

Depends where you are - In the area around the Mayo Clinic in Minnesota, or in the Puget Sound, return of spontaneous circulation rates can approach 40+% for witnessed treatable arrythmias.

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

#96

Post by JshWright »

FireBeyond wrote: post #83
JshWright wrote: post #47

Earlier quoted context omitted.

Do you have access to an on-call physician? Would a provider at some level less then 'physician' (e.g. nurse practitioner or paramedic) be able to use the kit if they're in contact with a physician? It would be extremely frustrating to watch someone die (or at least get sicker), knowing there was equipment on board that could help them...

Law and regulations vary, but essentially you can "practice" under the license of a physician (and in fact, throughout the US, that's how EMTs and Paramedics operate, through an agency or county Medical Protocol Director). Everything in that bag is likely able to be used autonomously by a paramedic - it deals with acute care, not chronic, which unsurprisingly is what paramedics are used to dealing with: * childbirth…

Yeah, I was looking to clarify if there was some sort of medical control available.

I know for a fact that some airlines do have an on-call physician (the medical director for my paramedic program was one years ago, in addition to providing state-wide medical control for all flight based EMS services), I was just curious if the OP's airline did.

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

#97

Post by ibejoeb »

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.)

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

#98

Post by herdrick »

JshWright wrote: post #92
herdrick wrote: post #89

Earlier quoted context omitted.

Semi-conscious, if I recall correctly, covers a wide range of responsiveness. She was unable to stand and slow to respond to questions but was well-oriented w.r.t. person, place and time. Drinking water wasn't a problem. The possible danger is that they'll vomit it up after passing out, or that they have some issue that requires emergency surgery. Now you've put something in their stomach that they might vomit during…

No, the possible danger is that they'll aspirate the water and you'll compromise their airway. Sounds like she wasn't semi-concious though, just tired, and maybe a little lethargic.

Of course, if they are that badly out of it - I decided she wasn't. It sounds like I used the wrong term, thanks. Fixed.

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

#99

Post by lostlogin »

umsm wrote: post #62

I have one question regarding the question: "Did you end up getting sued?" Why would the doctor get sued? Why would that question even be asked? I didn't feel like any type of catastrophic event happened to merit a lawsuit.

You'd be surprised. A course was held recently on in air medicine here in NZ. The airline running the course said that they would foot any resulting legal bills that resulted, from anywhere on earth. However there was one condition - medical staff called when on a plane will give their time for free. The airline had received invoices for medical staff time in the recent past.

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

#100

Post by lostlogin »

cockerham wrote: post #75
cynwoody wrote: post #49

Earlier quoted context omitted.

That's a pet peeve of mine, also. There's usually a date, but often not near the top and/or not in a standard format. Then there are these sites that use relative times, e.g., 0 minutes ago, or 865 days ago ... In the current case, there is a timestamp of sorts at the bottom of the page: "Updated December 27, 2012 Copyright 2012 Cockeyed.com". Here is blog owner's About page, last updated January 27, 2012: http://www…

Is there some form of timestamp which is better than the full date at the bottom of the page?

Personally I find it useful when it says it was an hour ago, or a day ago, or 3 days ago etc up to a week. Then the date is what I want.
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