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Interesting story and I can partially confirm. I have responded to a few on-flight emergencies on international flights and experience varies according to the a

by paviva 10y ago

Interesting story and I can partially confirm. I have responded to a few on-flight emergencies on international flights and experience varies according to the airline. Lufthansa has a really great kit to deal with agitated passengers, but nothing to deal with pain. Air Canada's kit is pretty worthless. Most airlines fall in between. That being said, I find the doctor's requirement a bit unrealistic. Airways ? Common, good luck placing an airway in the cramped flight conditions. A BVM [1] would be more useful. IVs ... Completely useless, too. First, unless you have a good nurse on board, you wont be able to open up a good vein. Second, you cannot expect airways companies to store enough of IV fluids to make a difference either way. Third, fluids don't save lives unless you have other medications coming in the next few minutes. The lack of nitro might be a good thing too. Rarely useful, and most likely to result in the passenger passing out/dying than helping anyone.

ackfoo 10y ago
What an odd reply. I have placed airways in helicopters and Piper twin-engine aircraft that were serving as air ambulances. Those are far more cramped than a commercial airliner. Control of the airway can make all the difference when things go bad in a hurry. IV fluids are critical in dehydration--no drugs to follow. Oh. I wrote the foregoing and then I re-read the part about "a good nurse...open up a good vein" and I realized you are a troll with no medical experience or qualifications. Good one.
- JshWright 10y ago
  > IV fluids are critical in dehydration--no drugs to follow. If someone was able to walk on a plane, it's unlikely they are severely dehydrated... Plenty of other reasons to carry fluids though.
  - neurotech1 10y ago
    Actually, being at 30,000+ feet the air is extremely dry. Getting severely dehydrated during the flight is quite possible. More so if alcohol is involved.
- paviva 10y ago
  I'm sorry, but I'm not aware of any airline stocking combitubes[1] or similar easy airways (or at least an i-gel LMA). A Guedel can be useful sometimes, but that's it. Unless you have a rare scenario where you've got an anesthesiologist/experienced paramedic, it is completely unrealistic to expect a random doctor to be able to use anything else. [1] https://en.wikipedia.org/wiki/Combitube https://en.wikipedia.org/wiki/Combitube
  - JshWright 10y ago
    I'm actually a fan of the King airway over the Combitube (much harder to screw up...)
    - paviva 10y ago
      We don't have those in Canada for some reason, but I do agree, King is good.
      - JshWright 10y ago
        The problem with any of those though is that you have now inflated a balloon inside your patient in a low pressure environment. You'd better remember that when you descend and the balloon deflates...
paviva 10y ago
[1] BVM : https://en.wikipedia.org/wiki/Bag_valve_mask https://en.wikipedia.org/wiki/Bag_valve_mask
JshWright 10y ago
An 'airway' doesn't necessarily mean an ET tube. A simple airway adjunct (NPA, OPA, LMA, etc) would go a long way towards keeping an unresponsive pt's airway open without having to dedicate someone to monitoring it. IV access is useful for administration of several drugs that airlines (in the US anyway) are required to carry. While lots of docs haven't placed an IV since residency, it's not _that_ hard a skill, and it's more than just nurses who start a lot of IVs... A nurse wouldn't even be my first choice in that situation. I'd hope there was a paramedic (or ER nurse) aboard. As far as IV fluids go... There are plenty of situations where a 250-500mL bolus can make a significant difference. Given the limited diagnostic tools available, I'd give fluids to anything that smelled like an MI (barring any contraindications). For all you know it's an inferior wall MI, and that boost to their preload will help tremendously.
- paviva 10y ago
  HN is not a place to argue medicine, but given that you're an EMT, I'll comment a little further. 1. Placing an IV in a sick, clamped patient IS difficult, even for experienced ER nurses. If the patient is not sick, he doesn't need an IV. Its way easier to give drugs directly with a syringe than setting up an IV first. 2. In those situations, I'll just lift the patients legs up to give him that 500 mL bolus, which will take exactly 10 seconds, and not require any skills at all. Bonus points, if I realize he's not fluid-depleted, I'll just them back on floor -- et voilà!.
  - JshWright 10y ago
    I'm a paramedic. I place IVs in "sick, clamped patients" all the time, often in a moving vehicle... I still maintain it's not that hard (the doc in the article managed it twice). You're not going to buy 500 mLs by raising someone's legs... 250, maybe. And if they _do_ have a positive response, you'd still hold off on fluids? I see it as more of a friendly discussion than an argument, but I'll certainly respect your wishes if you'd rather not...
    - paviva 10y ago
      It was in the sense of that kind of discussion probably not interesting to most people on HN. I don't doubt you place IVs in sick patients, I only doubt those IVs make any difference. I am not very familiar with prehospital/EMT literature, and I don't know if any studies have been done, and I certainly don't have any hard data, but I do prefer when paramedics give aspirin, stick in a combi-tube, do basic stuff, and just rush the patient to the hospital instead of wasted time installing and IV on-site, giving fluids and what not. I've seen a great many "heart attacks" treated with fluids in full-blown congestive heart failure. This is anecdotal of course. Again, for the 500 bolus, I am not aware of any literature to support it as a life-saving measure, and I do believe that if the patient is gonna code without a 500 bolus, he will code with a 500 bolus, too. We're talking of a previously healthy person suddenly dying here -- in those scenario fluid rarely makes a different unless its profuse bleeding, in which case 500 mL is not enough anyways. The big problem I see with fluids, stethoscopes, IV benadryl, and the like, is that these things are DISTRACTIONS that make people waste their time trying to get a blood pressure when its obvious the patient's in shock (or equally obvious he isn't). A quick, focused history and exam + Epi + AED + Albuterol are the real life-savers and where the emphasis should be on.
cosmotron 10y ago
> I find the doctor's requirement a bit unrealistic. The article states that these items (airways, nitro, ...) were not just her requirements, but rather FAA mandated [1] items that did not appear in the flight's medical kit. [1] http://www.faa.gov/documentLibrary/media/Advisory_Circular/AC121-33B.pdf http://www.faa.gov/documentLibrary/media/Advisory_Circular/A...

by paviva 10y ago

ackfoo 10y ago

What an odd reply. I have placed airways in helicopters and Piper twin-engine aircraft that were serving as air ambulances. Those are far more cramped than a commercial airliner. Control of the airway can make all the difference when things go bad in a hurry. IV fluids are critical in dehydration--no drugs to follow. Oh. I wrote the foregoing and then I re-read the part about "a good nurse...open up a good vein" and I realized you are a troll with no medical experience or qualifications. Good one.

JshWright 10y ago
> IV fluids are critical in dehydration--no drugs to follow. If someone was able to walk on a plane, it's unlikely they are severely dehydrated... Plenty of other reasons to carry fluids though.
- neurotech1 10y ago
  Actually, being at 30,000+ feet the air is extremely dry. Getting severely dehydrated during the flight is quite possible. More so if alcohol is involved.
paviva 10y ago
I'm sorry, but I'm not aware of any airline stocking combitubes[1] or similar easy airways (or at least an i-gel LMA). A Guedel can be useful sometimes, but that's it. Unless you have a rare scenario where you've got an anesthesiologist/experienced paramedic, it is completely unrealistic to expect a random doctor to be able to use anything else. [1] https://en.wikipedia.org/wiki/Combitube https://en.wikipedia.org/wiki/Combitube
- JshWright 10y ago
  I'm actually a fan of the King airway over the Combitube (much harder to screw up...)
  - paviva 10y ago
    We don't have those in Canada for some reason, but I do agree, King is good.
    - JshWright 10y ago
      The problem with any of those though is that you have now inflated a balloon inside your patient in a low pressure environment. You'd better remember that when you descend and the balloon deflates...

paviva 10y ago

[1] BVM : https://en.wikipedia.org/wiki/Bag_valve_mask https://en.wikipedia.org/wiki/Bag_valve_mask

JshWright 10y ago

An 'airway' doesn't necessarily mean an ET tube. A simple airway adjunct (NPA, OPA, LMA, etc) would go a long way towards keeping an unresponsive pt's airway open without having to dedicate someone to monitoring it. IV access is useful for administration of several drugs that airlines (in the US anyway) are required to carry. While lots of docs haven't placed an IV since residency, it's not _that_ hard a skill, and it's more than just nurses who start a lot of IVs... A nurse wouldn't even be my first choice in that situation. I'd hope there was a paramedic (or ER nurse) aboard. As far as IV fluids go... There are plenty of situations where a 250-500mL bolus can make a significant difference. Given the limited diagnostic tools available, I'd give fluids to anything that smelled like an MI (barring any contraindications). For all you know it's an inferior wall MI, and that boost to their preload will help tremendously.

paviva 10y ago
HN is not a place to argue medicine, but given that you're an EMT, I'll comment a little further. 1. Placing an IV in a sick, clamped patient IS difficult, even for experienced ER nurses. If the patient is not sick, he doesn't need an IV. Its way easier to give drugs directly with a syringe than setting up an IV first. 2. In those situations, I'll just lift the patients legs up to give him that 500 mL bolus, which will take exactly 10 seconds, and not require any skills at all. Bonus points, if I realize he's not fluid-depleted, I'll just them back on floor -- et voilà!.
- JshWright 10y ago
  I'm a paramedic. I place IVs in "sick, clamped patients" all the time, often in a moving vehicle... I still maintain it's not that hard (the doc in the article managed it twice). You're not going to buy 500 mLs by raising someone's legs... 250, maybe. And if they _do_ have a positive response, you'd still hold off on fluids? I see it as more of a friendly discussion than an argument, but I'll certainly respect your wishes if you'd rather not...
  - paviva 10y ago
    It was in the sense of that kind of discussion probably not interesting to most people on HN. I don't doubt you place IVs in sick patients, I only doubt those IVs make any difference. I am not very familiar with prehospital/EMT literature, and I don't know if any studies have been done, and I certainly don't have any hard data, but I do prefer when paramedics give aspirin, stick in a combi-tube, do basic stuff, and just rush the patient to the hospital instead of wasted time installing and IV on-site, giving fluids and what not. I've seen a great many "heart attacks" treated with fluids in full-blown congestive heart failure. This is anecdotal of course. Again, for the 500 bolus, I am not aware of any literature to support it as a life-saving measure, and I do believe that if the patient is gonna code without a 500 bolus, he will code with a 500 bolus, too. We're talking of a previously healthy person suddenly dying here -- in those scenario fluid rarely makes a different unless its profuse bleeding, in which case 500 mL is not enough anyways. The big problem I see with fluids, stethoscopes, IV benadryl, and the like, is that these things are DISTRACTIONS that make people waste their time trying to get a blood pressure when its obvious the patient's in shock (or equally obvious he isn't). A quick, focused history and exam + Epi + AED + Albuterol are the real life-savers and where the emphasis should be on.

cosmotron 10y ago

> I find the doctor's requirement a bit unrealistic. The article states that these items (airways, nitro, ...) were not just her requirements, but rather FAA mandated [1] items that did not appear in the flight's medical kit. [1] http://www.faa.gov/documentLibrary/media/Advisory_Circular/AC121-33B.pdf http://www.faa.gov/documentLibrary/media/Advisory_Circular/A...