Woman on American Airlines flight saved by doctor

[coroner]

https://www.msn.com/en-us/news/us/woman-on-american-airlines-flight-saved-by-doctor

Good thing there was an EP fellow, probably one of the more qualified specialties to handle that type of situation. As a pathologist, I'm not sure what I would've done. Situations like these would worry me if there's no other medical professionals on board and it's just me and the stewardesses... Either way, glad the pt. was ok.

Kudos to the EP fellow for stepping up and helping the pt. who went into anaphylactic shock. But, do you all think the flight attendants would've also figured out to administer the Epi-pen if she wasn't breathing; and, hence have saved her life as well in the same situation without a physician on board?

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[jwk]

https://www.msn.com/en-us/news/us/woman-on-american-airlines-flight-saved-by-doctor

Good thing there was an EP fellow, probably one of the more qualified specialties to handle that type of situation. As a pathologist, I'm not sure what I would've done. Situations like these would worry me if there's no other medical professionals on board and it's just me and the stewardesses... Either way, glad the pt. was ok.

Kudos to the EP fellow for stepping up and helping the pt. who went into anaphylactic shock. But, do you all think the flight attendants would've also figured out to administer the Epi-pen if she wasn't breathing; and, hence have saved her life as well in the same situation without a physician on board?

Kudos to the doc, and not discounting his efforts in any way - but not sure why an EP fellow is necessarily "one of the more qualified specialties to handle that type of situation".

 

[dchz]

"ane is the MOST QUALIFIED specialty to handle that type of situation"

Fixed that for ya

 

[vector2]

EP? You mean the guys who day in and day out request deep sedation for an 8 hr arrhythmia mapping on a 400lb OSA'er with COPD and NICM EF 15%? Yea they're real geniuses.

 

[chocomorsel]

Kudos to the doc, and not discounting his efforts in any way - but not sure why an EP fellow is necessarily "one of the more qualified specialties to handle that type of situation".

Well the OP says he/she is a pathologist. So compared to a pathologist, who deals with dead patients, then yes, an EP fellow is one of the best people to handle this.
I would say a cardiologist, pulmonologist, ER doc, Anesthesiologist, and IM/FM would be the "more" qualified ones to handle these types of situations.

 

[chocomorsel]

EP? You mean the guys who day in and day out request deep sedation for an 8 hr arrhythmia mapping on a 400lb OSA'er with COPD and NICM EF 15%? Yea they're real geniuses.

Come on guys. Really?

 

[anbuitachi]

one of the few things you can actually somewhat treat on an airplane

 

[Psai]

Come on guys. Really?

It's not like it ain't true

 

[vector2]

Come on guys. Really?

EP's have structural and physiologic knowledge of the heart that even as an echo/cardiac nerd I could never dream of attaining, but I maintain that on average they're piss-poor at understanding the gestalt of resuscitation and the management of sick patients. In a bystander undifferentiated arrest situation, I'll take an ER doc, intensivist, or anesthesiologist all day long.

 

[nimbus]

EP? You mean the guys who day in and day out request deep sedation for an 8 hr arrhythmia mapping on a 400lb OSA'er with COPD and NICM EF 15%? Yea they're real geniuses.

Your EP guys need to be trained. All ours get ga/ett. Easy peasy.

 

[vector2]

Your EP guys need to be trained. All ours get ga/ett. Easy peasy.

I said they request deep sedation. I didn't say that's what the eventual plan ends up being.

 

[coroner]

What I meant by "probably one of the more qualified specialties to handle that type of situation" was someone who already did IM + cardio would be better trained than someone like me (Path), or a specialty like Rads, Psych, Medical Genetics, etc.

No one ever answered the original question because people decided to bash EP instead...

Do you all think the flight attendants would've also figured out to administer the Epi-pen if she wasn't breathing; and, hence have saved her life as well in the same situation without a physician on board?

 

[anbuitachi]

What I meant by "probably one of the more qualified specialties to handle that type of situation" was someone who already did IM + cardio would be better trained than someone like me (Path), or a specialty like Rads, Psych, Medical Genetics, etc.

No one ever answered the original question because people decided to bash EP instead...

Do you all think the flight attendants would've also figured out to administer the Epi-pen if she wasn't breathing; and, hence have saved her life as well in the same situation without a physician on board?

Nah, but every doctor knows when in doubt, inject epi.

 

[pgg]

The only thing that surprises me about this event is that there were FOUR epipens available in the first place.

I bet that EP doc is embarrassed by all the attention ... "uh, guys, all I did was stick her with a couple epipens" ...

If that guy's nickname isn't Epipen for the rest of his fellowship, there's no justice in the world.

 

[drErassified]

Well the OP says he/she is a pathologist. So compared to a pathologist, who deals with dead patients, then yes, an EP fellow is one of the best people to handle this.
I would say a cardiologist, pulmonologist, ER doc, Anesthesiologist, and IM/FM would be the "more" qualified ones to handle these types of situations.

I thought you need to be internal medicine and cardiologist to be an EP doc.......

 

[drErassified]

EP's have structural and physiologic knowledge of the heart that even as an echo/cardiac nerd I could never dream of attaining, but I maintain that on average they're piss-poor at understanding the gestalt of resuscitation and the management of sick patients. In a bystander undifferentiated arrest situation, I'll take an ER doc, intensivist, or anesthesiologist all day long.

Ooohhhh......The echo nerd is jealous.....lol

 

[chocomorsel]

I thought you need to be internal medicine and cardiologist to be an EP doc.......

Yes. What’s that got to do w my post?

 

[vector2]

Ooohhhh......The echo nerd is jealous.....lol

Oh man, what a sick burn!!! Mods, please delete my account so I can resign from the internet in shame

 

[Iso4ane]

EP? You mean the guys who day in and day out request deep sedation for an 8 hr arrhythmia mapping on a 400lb OSA'er with COPD and NICM EF 15%? Yea they're real geniuses.

But who's enabling them. We are. The next time they say it's 'just' sedation, tell its like doing the procedure with just a 20G angiocath as their sheath. I'm sure they could make it work if they plan ahead. Who cares if its a major pain in the rear.

 

[vector2]

But who's enabling them. We are. The next time they say it's 'just' sedation, tell its like doing the procedure with just a 20G angiocath as their sheath. I'm sure they could make it work if they plan ahead. Who cares if its a major pain in the rear.

I agree 100%, but it's a problem when your entire group isn't on the same page. Our EP volume is low enough and the patients I've staffed are sick enough that it hasn't been a problem when I say I'm not doing the case without general and/or a-line, but I can see it being an issue if your colleagues are more cavalier with MACs and you end up being the one who always gives EP a hard time.

Hell, literally earlier today my colleague agreed to MAC a vtach ablation. Hx of CABG, AICD, ICM EF 20-30%. Prop and neo gtt with no a-line. The story I heard was it was going fine for about an hour and a half and then the heart gets tickled in a way it didn't like. Brady down to 35-40's, CRNA pushes ephedrine/glyco, NIBP cycles 80/45. CRNA immediately tries for carotid pulse. Nothing there. OR code called. Pt gets intubated, epi, shock, compressions for vfib and PEA but finally there's ROSC. Sats won't come up above 92% after this mess is over. Pt now sitting in the unit after what was supposed to be a "routine" procedure.

 

[Psai]

I agree 100%, but it's a problem when your entire group isn't on the same page. Our EP volume is low enough and the patients I've staffed are sick enough that it hasn't been a problem when I say I'm not doing the case without general and/or a-line, but I can see it being an issue if your colleagues are more cavalier with MACs and you end up being the one who always gives EP a hard time.

Hell, literally earlier today my colleague agreed to MAC a vtach ablation. Hx of CABG, AICD, ICM EF 20-30%. Prop and neo gtt with no a-line. The story I heard was it was going fine for about an hour and a half and then the heart gets tickled in a way it didn't like. Brady down to 35-40's, CRNA pushes ephedrine/glyco, NIBP cycles 80/45. CRNA immediately tries for carotid pulse. Nothing there. OR code called. Pt gets intubated, epi, shock, compressions for vfib and PEA but finally there's ROSC. Sats won't come up above 92% after this mess is over. Pt now sitting in the unit after what was supposed to be a "routine" procedure.

No mortality difference though amirite