Anyone medical on board?

I was fully immersed in a fantastic memoir, Angela’s Ashes, sitting in an aisle seat on my flight back from Wisconsin to Reno last weekend, when I heard someone call out, “Is there anyone medical on board?”  I looked up from my book and saw a man on all four knees in the aisle a few seats ahead of mine, as if he was searching for something he dropped under a seat.  But then I saw the desperate look on the face of the flight attendant who was looking around for any raised hands.  Here we go, I thought, as I carefully handed my cup of coffee to the guy next to me, snapped my tray up, and dumped my book and phone in my seat.  I jumped up and over the man on the floor, landing by his head. 

He was drenched in sweat, barely conscious, still on all fours.  “Sir?” I prompted him as he tried to sit up on his knees.  He was able to stay upright for a half second before he passed out onto me, his head landing on my bent knee.  There was a woman at his feet, looking expectantly at me, and I assumed she was a flight attendant.

I put my finger on his wrist over the radial pulse and asked, “Are you having any chest pain?” As I’m thinking, Oh my God, is he having a heart attack?

“No,” he whispered.

I quickly followed up with, “Are you short of breath?” Did he throw a clot and has a pulmonary embolus?”

“No,” he again softly replied as he continued to sweat.

“Are you dizzy?” I asked.  Is he having a stroke?

“Yes, very dizzy,” he managed to get out while keeping his eyes closed.

“Do you have a headache?” I followed up with.  Is he having a brain bleed?”

“No, no headache” he answered to my relief. 

“Are you nauseous?”  Is he going to throw up and does he need an emesis bag?

“Yes, that’s why I got up to go to the bathroom as I thought I was going to be sick,” he responded, his voice now louder and with more life in it.

“Has this ever happened to you before?” I asked.  What is his medical history?

“No, and I fly all the time,” he said.

I looked up at the woman assisting me and asked her to grab my stethoscope out of my backpack which was right next to her under the seat.  I had it with me as I was returning from my traveling physician job. 

“I have one here,” she responded as she pulled one out of a small black medical supply bag.  She had already put a pulse oximeter on his finger, a little device that measures heart rate and oxygen saturations.  I knew he had a normal pulse rate as I had felt it on his wrist, and I was relieved to see that his oxygen was okay.  She handed me the stethoscope and I told her we needed a blood pressure.  

I returned my attention to the passenger, who was more alert and slightly less sweaty. 

“What’s your name sir?” I asked, to which he responded “Tim.”*

“Tim, do you have a history of heart disease?” I asked.  This could still be a heart attack.

“Yes, I had a heart stent placed eight months ago,” he answered, further fueling my concern.

“And you’re not having any chest pain right now, correct?”  I again asked.

“No, no chest pain,” he said.

“Tim, did you take any blood pressure medications this morning?”  Is this iatrogenic?  Caused by one of his medications? 

“No,” he responded as I looked at the woman assistant and she reported to me his blood pressure was 96/44.  He needs IV fluids.

 I looked up at the flight attendant.  “How far are we from, Reno?”  I asked.

 “Twenty minutes,” she replied, “and emergency medical services have already been contacted and will be waiting at the gate.  We will get him off the plan first before other passengers.”

I returned my focus to Tim, still with his head in my lap on the floor in the aisle, though no longer sweating, “Are you on a blood thinner Tim?”  If he’s having a heart attack or stroke he needs aspirin.

“Yes, though I can’t remember the name,” he answered.

“Was it aspirin or Plavix?” I asked.

“No,” he answered.

“Coumadin or Eliquis?” I continued.

“No, not those either,” he replied.

“Tim, do you take any other medications?” I asked, as I tried to hear his heart rhythm with the stethoscope, to no avail due to the loud plane engine humming in the background.  

“No…what do you think is happening doc?” he asked with fear in his voice.

“I’m not sure but I’m worried about your heart,” was my honest reply. 

“Tim, did you happen to move your bowels when you were in the restroom?”  Did he have a vasovagal response?

“No, not since last night,” he replied.

“Have you been drinking?” I asked.  Is he drunk? Hungover?

“I had a few cocktails last night, the only alcohol I’ve had all month as I was trying to do a dry January,” he replied.

“Have you eaten or had any fluids today?” I asked.  Is he hungry or severely dehydrated?

“I had lunch before I got on the flight, and I probably haven’t had enough water today,” he answered with increasing confidence in his voice.  Did he eat something bad for lunch?

I looked at the assistant again, noticing she was writing vital signs on her hand like a pro. 

“What’s his pressure now?” I asked her.

“102/52,” she replied with some relief in her voice.

“I’m feeling better,” Tim remarked, looking up at me.

“Do you think you can drink some water, or are you too nauseous?”  He needs fluids asap.

“Yes, I can try,” he replied as I handed him a small bottle of water.

Still lying down, he picked up his head just enough to down the water, then returned his head to my knee. 

The minutes are ticking by, and I can feel the start of the plane’s descent. 

“I think I can try to sit up,” Tim told me. 

“Ok, but go slow,” I responded as he sat up on his knees.

“Have some more water,” I said, handing him another bottle. 

He drank the bottle of water, sat for a few more minutes, then we helped him stand up.  I looked into his eyes to catch the early signs of him fainting again.  His eyes stayed open, no sweating, no eyelid fluttering, no swaying of his body.  Phew.  Probably not a heart attack or anything serious. 

He had to use the restroom and we followed him to the back of the plane.  I’m still worrying about his heart and concerned that he’s now in the bathroom by himself.  He emerged a few minutes later, still pale, and we lead him back to his seat.

Minutes later we landed, and the pilot tells us all to stay in our seats.  Four emergency medical technicians come onto the plane, walk to his seat, and escort him out for further evaluation.

I turn to the woman who had assisted me, who happened to be sitting in a seat just across the aisle.  I introduce myself and find out she’s a pediatric nurse and was happy there was a doctor on board, as she was used to caring for children and adolescents, not grown men.  We were both relieved he didn’t need any more medical assistance (like CPR!), and we laughed nervously, releasing some of the tension that had built up in our bodies.

The flight attendants profusely thanked her and I, multiple times, and got our contact information as we were leaving the plane.  I found Tim in a private area outside the gate, sitting back in a chair with EKG leads on his chest and legs. 

“Hey Doc, thanks so much,”  He said as I walked up.

“How are you feeling now Tim?” I asked.

“I feel fine,” he replied, “I’m just letting them practice doing the EKG.”

“Well, I still recommend you get your heart checked out, and I’m glad you are okay,” I responded. 

We shook hands and I walked down to baggage claim, met my husband and shared with him what had happened. 

The following day I got a phone call from a representative from the airline.  They thanked me for my volunteer medical assistance and reminded me that I was protected by the good Samaritan Law, which legally protects a volunteer that gives medical assistance in an emergency.  The rep asked me if I had any suggestions or feedback.  I told her the only thing that would have been helpful was to have known what resources were available to me.  I was not aware there was a stethoscope or blood pressure cuff until the volunteer nurse told me.  The rep also told me that there was other treatment available on every plane: oxygen, IV fluids, and several different medications including nitroglycerin (used in heart attacks), Narcan (used in opiate overdoses), and Zofran (used for nausea).  I was glad I didn’t need these but may have offered them to Tim if he did not improve and I knew they were available. 

I also learned that medical emergencies occur in about 1% of flights, which actually sounds like a lot to me, given that at any time over the United States there are between 8,000 to 13,000 flights in the air.  I’m hoping for no more opportunities to arise in the next several months, as I have about a dozen scheduled flights coming up.  I feel more prepared moving forward however, and if I had the chance to assist again, I’d still jump up out of my seat. 

*not passenger’s real name