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- Mar 18, 2009
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So I was wrapping up my quick Vegas get-away, had managed to eat 12,000 calories in 3 days, and survived the onslaught of individuals standing on the strip, smacking small "escort" cards on their hands while trying to convince me to get one. "She is just what the doctor ordered" one fellow said. My girlfriend found it funny and irritating that these men would attempt to give me a "business card" right in front of her. I just found it funny. 
Time for departure... It was night time and as I boarded the aircraft I noted an older women siting in the front next to a man wearing a hat shaped like a condom. It's Vegas...what can I say.
"Flight attendants please be seated for departure" said the pilot. As we lifted off I looked at the strip one last time and wondered... how many zits can potentially spring up on my nose as I looked at my reflection on the aircraft window. My girlfriend said it was time for one of those nose strip things to clear the black heads.
The pilot gets on the overhead 38 minutes into the flight... "Eeeeehhhh, ladies and gentlemen we have reached cruise altitude. Should be a smooth ride, gigidy, and please remain seated with your seat belts on." (OK so I added the gigidy, but I can't help but think about that Family Guy episode where Quagmire is flying the aircraft and is talking on the overhead)
So then, 20 minutes later, just as I started sipping my soda I hear "Is there a doctor, nurse, paramedical on board? We are having a medical situation at the front of the aircraft." So my girlfriend and I just sat there for a couple of seconds and waited...no answer from anyone. We figured, we graduate this month and hopefully we'll be able to recognize sick vs not sick to some extent.
I pushed the call button and the flight attendants acknowledged. We both started making our way to the front of the aircraft and saw the condom hat bobbing arround. "You're kidding me" I thought... "He got stuck in the latex and now can't breath". However, it was the little old lady sitting next to him. She was huffin' and puffin' but alert and able to express her concerns.
"I...feel...out...of...air..." she said. She was the sweet typical gradma that went to Vegas for some fun and excitment. However, she sat there trying to tripod on the wall in front of her breathing fast with her lips pursed. I asked the flight attendent about the oxygen tanks they have on board. Not only did they have supplemental oxygen tanks and ACLS drugs but they had a decent stethoscope, BP Cuff, and gloves. Very nice...as Borat would say. My gf stood guard in case she passed out, coded, etc. We hooked it up and placed the breathing mask on her. Yes... the yellow little cups that go over your mouth that look like playdo containers with the little clear lunch bag hanging from them. I felt like saying...m'am please take eight vital capacity breaths. lol
So she's still working kind of hard to breath but I start getting vitals and collecting information. We find out she was an 80 year old lady with COPD/emphysema for the last 6 years, not on home oxygen, never intubated, quick hospital stay last year for COPD exacerbation, on albuterol tabs, Spiriva, and loratidine. Prior history of cancer surgically addressed with no recurrence. No allergies...last meal 3pm. 70 pack years, quit smoking 4 years ago.
Mean while my gf was working on the history of present illness. Aparently she had been getting progressively more short of breath for the last couple of days, while in Vegas, and got much worst during the flight. No chest pain, headache, dizzyness, abdominal pain, no leg pain...just increased cough from her baseline, with thicker green/yellow sputum. No hemoptysis. She denied ever getting anxious during flights. She denied accidentally swallowing anything down her trachea. Denied swelling of her extremities. Denied fever-like symptoms.
Her BP was 150/80, P 150, RR 38 initially but reduced to 130s/70s, P 100-110, RR 18-24 through the next hour as she sat with the oxygen mask on. She had reduced breath sounds on the left with an initiall bilat expiratory wheeze that was diminishing as time went on. Her cardiac sounds were hard to hear with the roar of the jets but tachy and regular with no apparent murmurs. Only change was decrease in heart rate as time when on. Her trachea was midline... no jvd or neck bruits. Neuro exam was grossly intact. Abd exam...obese pannus, rest normal. Extremities a bit cool, cap refil under 3 seconds. Nail beds and lips were not blue. Neg homan sign... but eh... GCS of 15 througout the flight.
The flight attendants got MedLink on line and explain what was going on. Then the attendants turn to us and ask... "You think we need to divert this flight? I know you guys are 4th year medical students but what do you think?" I was 50/50 (my lack of experience). It was reassuring that she was improving on the supplemental oxygen, breathing slower, and in better spirits. After talking to medlink and talking it over among all of us the decision was made to continue to our final destination and keep her on the oxygen.
Once we landed we were met by first responders who placed her on a monitor. Her SaO2 was 97 percent... whoo hoo
So initially we thought of the following...
- COPD exacerbation
- PE
- Anxiety
- Ischemia/MI
- Pneumothorax
The IMPACT mnemonic came in handy for SOB
On the ground the paramedics administered a quick breathing treatment. She did not want to go the the ED and said she would touch base with the PCP in the morning or have her next of kin drive her to the hospital she usually goes to.
This would have been a good story during interview season, but hey, emergencies are never planned for the perfect moment...
Time for departure... It was night time and as I boarded the aircraft I noted an older women siting in the front next to a man wearing a hat shaped like a condom. It's Vegas...what can I say.
"Flight attendants please be seated for departure" said the pilot. As we lifted off I looked at the strip one last time and wondered... how many zits can potentially spring up on my nose as I looked at my reflection on the aircraft window. My girlfriend said it was time for one of those nose strip things to clear the black heads.
The pilot gets on the overhead 38 minutes into the flight... "Eeeeehhhh, ladies and gentlemen we have reached cruise altitude. Should be a smooth ride, gigidy, and please remain seated with your seat belts on." (OK so I added the gigidy, but I can't help but think about that Family Guy episode where Quagmire is flying the aircraft and is talking on the overhead)
So then, 20 minutes later, just as I started sipping my soda I hear "Is there a doctor, nurse, paramedical on board? We are having a medical situation at the front of the aircraft." So my girlfriend and I just sat there for a couple of seconds and waited...no answer from anyone. We figured, we graduate this month and hopefully we'll be able to recognize sick vs not sick to some extent.
I pushed the call button and the flight attendants acknowledged. We both started making our way to the front of the aircraft and saw the condom hat bobbing arround. "You're kidding me" I thought... "He got stuck in the latex and now can't breath". However, it was the little old lady sitting next to him. She was huffin' and puffin' but alert and able to express her concerns.
"I...feel...out...of...air..." she said. She was the sweet typical gradma that went to Vegas for some fun and excitment. However, she sat there trying to tripod on the wall in front of her breathing fast with her lips pursed. I asked the flight attendent about the oxygen tanks they have on board. Not only did they have supplemental oxygen tanks and ACLS drugs but they had a decent stethoscope, BP Cuff, and gloves. Very nice...as Borat would say. My gf stood guard in case she passed out, coded, etc. We hooked it up and placed the breathing mask on her. Yes... the yellow little cups that go over your mouth that look like playdo containers with the little clear lunch bag hanging from them. I felt like saying...m'am please take eight vital capacity breaths. lol
So she's still working kind of hard to breath but I start getting vitals and collecting information. We find out she was an 80 year old lady with COPD/emphysema for the last 6 years, not on home oxygen, never intubated, quick hospital stay last year for COPD exacerbation, on albuterol tabs, Spiriva, and loratidine. Prior history of cancer surgically addressed with no recurrence. No allergies...last meal 3pm. 70 pack years, quit smoking 4 years ago.
Mean while my gf was working on the history of present illness. Aparently she had been getting progressively more short of breath for the last couple of days, while in Vegas, and got much worst during the flight. No chest pain, headache, dizzyness, abdominal pain, no leg pain...just increased cough from her baseline, with thicker green/yellow sputum. No hemoptysis. She denied ever getting anxious during flights. She denied accidentally swallowing anything down her trachea. Denied swelling of her extremities. Denied fever-like symptoms.
Her BP was 150/80, P 150, RR 38 initially but reduced to 130s/70s, P 100-110, RR 18-24 through the next hour as she sat with the oxygen mask on. She had reduced breath sounds on the left with an initiall bilat expiratory wheeze that was diminishing as time went on. Her cardiac sounds were hard to hear with the roar of the jets but tachy and regular with no apparent murmurs. Only change was decrease in heart rate as time when on. Her trachea was midline... no jvd or neck bruits. Neuro exam was grossly intact. Abd exam...obese pannus, rest normal. Extremities a bit cool, cap refil under 3 seconds. Nail beds and lips were not blue. Neg homan sign... but eh... GCS of 15 througout the flight.
The flight attendants got MedLink on line and explain what was going on. Then the attendants turn to us and ask... "You think we need to divert this flight? I know you guys are 4th year medical students but what do you think?" I was 50/50 (my lack of experience). It was reassuring that she was improving on the supplemental oxygen, breathing slower, and in better spirits. After talking to medlink and talking it over among all of us the decision was made to continue to our final destination and keep her on the oxygen.
Once we landed we were met by first responders who placed her on a monitor. Her SaO2 was 97 percent... whoo hoo
So initially we thought of the following...
- COPD exacerbation
- PE
- Anxiety
- Ischemia/MI
- Pneumothorax
The IMPACT mnemonic came in handy for SOB
On the ground the paramedics administered a quick breathing treatment. She did not want to go the the ED and said she would touch base with the PCP in the morning or have her next of kin drive her to the hospital she usually goes to.
This would have been a good story during interview season, but hey, emergencies are never planned for the perfect moment...
