Your first day as a doctor

You give him 300mg of out-of-date aspirin. The cabin crew also hand you a portable oxygen cylinder that they managed to find knocking about, and you connect the patient to it. His BP is pretty low, so you lie him down and elevate his legs. You ask the cabin crew to put a tannoy out for GTN spray. Another passenger responds and rushes over to lend you his GTN spray. You give the patient a few puffs. His pain starts to ease.

Now what?

I'm pretty sure all planes have to have a defib on board.

You tell the cabin crew to contact the pilot. After a few minutes they give you a portable phone. It's the captain. He asks you how the patient is doing and what you would recommend.

You pause for a second. You look at the patient. He looks much better now. His pain is settled, he seems much more comfortable and his vitals are stable, for the time being. You then look out of the window. You are over the Atlantic, around 1 hour from New York. Finally, you look across the cabin. 350 passengers are staring at you, smiling. You turn to the patient one more time. He says he feels great.

The captain prompts you again. "What would you like to do doctor?"

First things first I'd make it clear again that I wasn't a doctor. I guess the description of your med student -> doctor transition you described to the crew didn't make it to the pilot, so it's important he realises too.

You reiterate to the captain the you are not a fully qualified doctor yet. He acknowledges this, but asks "What difference does it make? What would you like me to do?"

You reiterate to the captain the you are not a fully qualified doctor yet. He acknowledges this, but asks "What difference does it make? What would you like me to do?"

Basically, if you were chinese he would love you!

I would have added an experimental treatment to that - pre-conditioning is something that not many seem to know about (my lecturer on heart failure had gross misunderstandings about what it involved despite mentioning it in the lecture). Basically, you tourniquet the arm for say 5 minutes, release it for a couple, tourniquet for 5 again etc. This has been shown to greatly reduce damage from a myocardial infarction in dogs, and i think is currently under clinical trial/are setting up clinical trials.

They think the ischemia releases some systemic factor which allows the body to greater cope with ischemia, possibly to do with aldehyde dehydrogenases.

The reason i know about this is one of the guys in the lab i was working on was examining people with different enzyme isotypes to see how it affected reactive hyperemia in the arm. Basically, if you were chinese he would love you!

bc of having some different enzymes?

Chinese people have different ADH type yes - that is why they respond strongly to alcohol (going red etc)

Isn't that just to do with reducing cardiac preload by inhibiting venous return? In medieval times, heart failure was treated by therapeutic blood letting.

Getting quite technical though! Also I don't think the patient would approve of a experimental trial in the middle of a heart attack!

Yep, indeed.

(How) does that relate to the study you mentioned?

Well they seemed to think this mystery systemic factor that was protecting the dogs was to do with ADH, so this researcher was testing different ADH types to see if it made a difference.