No, We Don’t Need to Land in Scotland!

May 2, 2009
Fish or chicken? Should've had the pasta.

Fish or chicken? Should've had the pasta.

As I had mentioned before, I am on vacation for the next couple of weeks. I thought I would be getting away from the stupidity of swine flu (now called H1N1 flu to protect pork sales), but it looks like I landed right in the middle of stoopid yesterday.

I’m on an international flight and heading towards Europe. Mid-way through the flight I see a crowd gather near one of the galleys and then a frantic sounding flight attendant gets on the mic and calls for one of her associates. I figured it was likely a medical emergency of some sort and followed the hurried attendant.

At the galley, I find a young man laying on the floor breathing O2 through a mask with two disoriented looking passengers fiddling with him. I tell them that I am an ER doc and they tell me that they are paramedics from Europe. The story is that this guy got up to go to the bathroom and became presyncopal (almost fainted) and called for help. I ask the scared looking flight attendant for the medical kit so I can assess this guy.

Now of course, everyone is worried about one thing – SWINE FLU. I can read their scared minds … “Oh no! We’re all gonna get swine flu and die horrible deaths!”. But when I assess the patient, after pushing the very eager, overly wound up paramedics away, my first question is, “How much have you had to drink?” Previous experience with airline medical emergencies has taught me that, just like on the ground, alcohol factors into a lot of emergencies.

After establishing the fact that he didn’t have half a cart of Jack Daniels, my next set of questions focuses on flu symptoms (fever, nausea/vomiting, body aches, fatigue, cough, runny nose, etc.). He was only nauseated, likely from the near fainting. No medical history, on no medications.  Then I hear one of the paramedics talking with the flight attendant about an emergency landing in Scotland and I get really peeved.

Dealing with the totally awesome EMS personnel in the States, I get used to them understanding chain of command and knowing when to defer. I imagine that many EMS personnel in Europe are also the same, so not sure what was up with these jackers. I tell the flight purser that I am the medical doctor in charge and that an emergency landing is not necessary at this point in time and that everyone should chill. Too many cooks in the kitchen.

Getting back to the sick person, I observe another flight attendant trying to put the leads from the automatic defibrillator (AED) on the patient – one on the stomach and the other near the right shoulder. It was like doing a code on the floor – total cluster. I was totally expecting to see the “paramedics” preparing to inject this poor guy with some epinephrine or something.

So, what was the sick guy’s story? He was majorly sleep deprived (typical for many people preparing for international travel), been staying awake on lots of caffeine and probably not having enough fluids to replace all the ones he was urinating out. Add to that, the chicken meal he ate on board.

The AED shows a very temporary sinus bradycardia (slow heart beat) at about 40. While I was checking his blood pressure, it went back up to normal between 65-72. I think it was because he was overhearing the “paramedics” from Hell discussing totally inappropriate interventions. His blood pressure turned out to be 110/70. My team of boners tried to get a blood sugar and failed. But by this time, the guy was saying he was feeling better and wanting to sit up. His “fight or flight” response was probably in high gear overhearing the things being said.

Catastrophe averted for the moment. I told the sick guy to contact me directly if he started to feel woozy again and to avoid the “paramedics” at all costs. The flight attendants were thankful for the man’s quick recovery and for services provided.

In the last hour of the flight though, I was heading up near the sick guy’s seat and see his wife standing and looking concerned. He was feeling woozy again and luckily I arrived at the right time (read – before Beavis and Butthead). I had him lie down and put his feet up. Checked his pulse and it was regular at about 65. He was very nauseated again. To avert another medical emergency landing, I went to the head purser and told her that the guy was stable and not to be worried. I would stay with him until we landed and inform her of any changes.

Within minutes, the guy was feeling and looking back to normal – a good sign that he was likely dehydrated and getting vasovagal. A few nice passengers near-by offered to move so that he could lay down across four seats. Beavis and Butthead arrived soon enough with an O2 tank (incorrectly set-up). Once again, they by-passed me to tell the captain to land ASAP. I think one of them was trying to impress one of the attendants or something.

Just before we landed, sick guy vomited up his chicken. I was sitting right in front of him and immediately after I asked him if after vomiting he felt better or worse. Although it’s not so evidence-based, I have found over the years that with food-borne illnesses (commonly called “food poisoning”) that people generally feel better immediately after vomiting – likely because of the reduced toxin load in their stomach. On the other hand, vomiting from flu syndromes usually results in a person feeling even worse and more fatigued. Maybe it was the chicken after all?

We arrived to our destination after a hurried landing and had to wait on board until this country’s EMS came on board to load up the patient and take him to the airport medical facility. I gave report to the ER doctor that accompanied the team and gave my new friend (sick guy) some farewell advice and a good-bye. My advice was get some IV fluids and some rest. After he was gone, I had to reassure several passengers that there was no flu threat and that they should all be ok.

That is, unless they had the chicken. Glad I ate the pasta.

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