Sunday, July 19, 2009
Is There A doctor On This Plane?
I was on a flight to Alaska (for a medical meeting) and the flight attendant came on the intercom "Is there a doctor on the plane? We need assist for a passenger." If you read my blog on Doctors as Good Samaritans, you already know my hand went up. This is the first time I've done an airplane rescue.
The 82 year old gentlemen was in first class (Alaska Airline first class is like coach..not very roomy), traveling to a cruise with his wife. He had gotten up to go to the bathroom and almost collapsed.
Doctors can assess a situation very quickly by just LOOKING at the patient. He was sitting in a seat, conscious, but pale and clammy. Pulse not detectable. Able to speak but not able to really give me a good history. A quick look at his chest as I unbuttoned his shirt told me he had had major cardiac surgery (Chest zipper sign). That already told me a lot.
First questions; "Are you having chest pain?" "No". "Are you nauseated?" "No". Blood pressure was difficult due to plane noise but was low...95 systolic. For older people we want to see that pressure at least over 110.
We put some oxygen on him and he started looking a little better. Wife told me he was a diabetic and she had his test kit so we quickly got a finger stick glucose...280. That's high but not the cause of the problem. I would have been concerned if it were below 100 (hypoglycemia).
My assessment was helped tremendously by the fact that his wife had a MEDICATION LIST. I could quickly rule out certain diagnoses with a quick glance at his medications. Insulin, Coumadin (that ruled out a pulmonary embolus or blood clot), Blood pressure meds, high cholesterol meds, potassium, arthritis, gout. There were about 15 different medications and I was told he had taken them in the morning.
According to his wife, they had been traveling all day, had been going through airports in a wheelchair. He was fine until he tried to stand up.
The patient got his color and cognition back with the oxygen and a little orange juice. I spoke via phone to the captain and a ground EMT. I stayed with him to make sure all was well for over an hour and decided the plane did not need to do an emergency landing nor did we need an ambulance at the destination. I stayed with him getting off the plane (last) and made sure his wheelchair was ready, transport was there and that he would go directly to an Emergency department in Anchorage for an EKG and labs before setting off on the cruise the next day.
The whole event had a satisfactory outcome and I hope he just had a syncopal episode because he is a frail guy traveling. I advised him he probably needs oxygen all the time because when he exerted himself, he got a little pale again. A full blown assessment was indicated.
I went back to my cramped seat in coach and ate my pretzels. Just another day!
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