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    (Original post by LaRoar)
    First things first, I get that this is a very pressing emergency, but I'd make it very clear to everyone present (including Japanese man, but fortunately I can speak some Japanese!) that I'm not a licenced doctor yet.

    I would carry out basic first aid tasks such as supporting him against a wall with his knees drawn up to his chest (iirc) and then do as many observations such as resp rate, pulse rate that I could without any equipment while I wait for the real doctors to arrive and take over.
    The cabin crew acknowledge that you're not a fully qualified doctor yet, but unfortunately you are the only person on board who can help. Thankfully, the patient speaks English. You take a history from him and do some observations. To cut a long story short, it is clear that he is having a heart attack. You are 40,000 feet over the atlantic ocean - it will be several hours before medical help can take over.

    Now what?
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    (Original post by electricjon)
    You make your way to the back of the cabin and introduce yourself to the staff. Looking relieved, they rush you over to where a man is sitting. He is Japanese, in his 50's and dressed in a sharp suit. He is clutching his chest and complaining of crushing pain. He looks terrible - pale, sweaty, clammy, breathless.

    Now what?
    Ok, since he's sweaty and breathless does this suggest it is cardiac related?

    And the patient speaks perfect English and he's a hedge fund manager who works between NY/Lon/Tokyo.
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    (Original post by electricjon)
    The cabin crew acknowledge that you're not a fully qualified doctor yet, but unfortunately you are the only person on board who can help. Thankfully, the patient speaks English. You take a history from him and do some observations. To cut a long story short, it is clear that he is having a heart attack. You are 40,000 feet over the atlantic ocean - it will be several hours before medical help can take over.

    Now what?
    Give him aspirin?

    Or maybe the patient has his own GTN spray?
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    (Original post by No Future)
    Ok, since he's sweaty and breathless does this suggest it is cardiac related?

    And the patient speaks perfect English and he's a hedge fund manager who works between NY/Lon/Tokyo.
    Indeed. From his history, he has all the major risk factors (high blood pressure, high cholesterol, diabetes, smoker, family history). In short, it's a classic textbook myocardial infarction happening right in front of you.
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    (Original post by electricjon)
    The cabin crew acknowledge that you're not a fully qualified doctor yet, but unfortunately you are the only person on board who can help. Thankfully, the patient speaks English. You take a history from him and do some observations. To cut a long story short, it is clear that he is having a heart attack. You are 40,000 feet over the atlantic ocean - it will be several hours before medical help can take over.

    Now what?
    Oops, I saw 'cruise ship' on the first post and missed the plane part. :rolleyes:

    Am I to assume that we're over the Atlantic with nowhere to land?
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    I'm also guessing that someone is legally obliged, or will have, to phone the airport(s) to inform the right people about the current situation? And if possible, get communication going between a much more qualified, experienced airport doctor who could help in the scenario.
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    Aspirin at this stage, no?
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    (Original post by No Future)
    Give him aspirin?

    Or maybe the patient has his own GTN spray?
    You ask the cabin crew for some aspirin and GTN spray. They don't know what you're talking about, but hand you the on-board medical pack. Looking through it, you find a stethoscope and sphygmomanometer (BP monitor) and a load of drugs, half of which you haven't heard of ever, as it is a US flight and so most of the medicines aren't UK standard. Nevertheless, you find some aspirin and sublingual GTN tablets. It's quite a budget airline though - you check the expiry date - it reads 2006. Still give it?
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    (Original post by electricjon)
    You ask the cabin crew for some aspirin and GTN spray. They don't know what you're talking about, but hand you the on-board medical pack. Looking through it, you find a stethoscope and sphygmomanometer (BP monitor) and a load of drugs, half of which you haven't heard of ever, as it is a US flight and so most of the medicines aren't UK standard. Nevertheless, you find some aspirin and sublingual GTN tablets. It's quite a budget airline though - you check the expiry date - it reads 2006. Still give it?
    Give him the aspirin and check his BP?
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    (Original post by electricjon)
    The cabin crew acknowledge that you're not a fully qualified doctor yet, but unfortunately you are the only person on board who can help. Thankfully, the patient speaks English. You take a history from him and do some observations. To cut a long story short, it is clear that he is having a heart attack. You are 40,000 feet over the atlantic ocean - it will be several hours before medical help can take over.

    Now what?
    Get the cabin crew to ask announce over the tannoy asking if anyone has any aspirin?
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    (Original post by electricjon)
    You ask the cabin crew for some aspirin and GTN spray. They don't know what you're talking about, but hand you the on-board medical pack. Looking through it, you find a stethoscope and sphygmomanometer (BP monitor) and a load of drugs, half of which you haven't heard of ever, as it is a US flight and so most of the medicines aren't UK standard. Nevertheless, you find some aspirin and sublingual GTN tablets. It's quite a budget airline though - you check the expiry date - it reads 2006. Still give it?
    No. Cause there's a problem if it starts to decompose into its acids? Am I right? EDIT: Mind, this is what I've learnt from school chemistry so it's probably wrong :rofl:

    Ask around on the flight. It's a transatlantic flight, so will probably be quite a big plane. There would be a lot of passengers and at least one of them will probably have aspirin.
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    Check BP, give him the aspirin and the GTN anyway (Surely it would be better than nothing in this situation?)
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    (Original post by electricjon)
    You ask the cabin crew for some aspirin and GTN spray. They don't know what you're talking about, but hand you the on-board medical pack. Looking through it, you find a stethoscope and sphygmomanometer (BP monitor) and a load of drugs, half of which you haven't heard of ever, as it is a US flight and so most of the medicines aren't UK standard. Nevertheless, you find some aspirin and sublingual GTN tablets. It's quite a budget airline though - you check the expiry date - it reads 2006. Still give it?
    Hmm the efficacy of the drugs will have been reduced. However the metabolite of aspirin is still active so I would give it a try. Alternatively ask all the passengers if anyone has aspirin
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    Oh, I read that as the aspirin was still in date, but the GTN was not?
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    (Original post by electricjon)
    You ask the cabin crew for some aspirin and GTN spray. They don't know what you're talking about, but hand you the on-board medical pack. Looking through it, you find a stethoscope and sphygmomanometer (BP monitor) and a load of drugs, half of which you haven't heard of ever, as it is a US flight and so most of the medicines aren't UK standard. Nevertheless, you find some aspirin and sublingual GTN tablets. It's quite a budget airline though - you check the expiry date - it reads 2006. Still give it?
    I have no idea. I'd like to open a line of communication quickly with a more qualified doctor on the ground to find out. At a guess, the aspirin could be toxic due to decomposition into it's constituant acids but I've no idea about the GTN and I've no idea of the rate of aspirin decomposition.
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    (Original post by Yellowmonkeyman)
    I have no idea. I'd like to open a line of communication quickly with a more qualified doctor on the ground to find out. At a guess, the aspirin could be toxic due to decomposition into it's constituant acids but I've no idea about the GTN.
    I'm no pharmacist but I wouldn't be too bothered about expiry dates. I doubt it's going to poison him and the potential benefits certainly outweigh the risks. Someone correct me if I'm wrong though. Tannoying the rest of the passengers for in-date aspirin and GTN is a brilliant idea though.
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    (Original post by electricjon)
    I'm no pharmacist but I wouldn't be too bothered about expiry dates. I doubt it's going to poison him and the potential benefits certainly outweigh the risks. Someone correct me if I'm wrong though. Tannoying the rest of the passengers for in-date aspirin and GTN is a brilliant idea though.
    Yep, it's not that long out of date anyway and in an emergency situation like that, I'd probably give it to the patient anyway if the tannoying fails .
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    (Original post by electricjon)
    I'm no pharmacist but I wouldn't be too bothered about expiry dates. I doubt it's going to poison him and the potential benefits certainly outweigh the risks. Someone correct me if I'm wrong though. Tannoying the rest of the passengers for in-date aspirin and GTN is a brilliant idea though.
    It shouldn't poison him. The major metabolite which it is most likely to have broken down into is still an active COX inhibitor so it still should work...
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    (Original post by spacepirate-James)
    I'm also guessing that someone is legally obliged, or will have, to phone the airport(s) to inform the right people about the current situation? And if possible, get communication going between a much more qualified, experienced airport doctor who could help in the scenario.
    Airport doctor? Airports don't employ resident doctors. They would have to get an expert doctor's opinion from a nearby hospital, but then again, whose responsibility would that be? Yours? The patients? The cabin crew? The airline? The airport? And how would you go about getting it at 40,000 feet?
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    (Original post by No Future)
    Give him the aspirin and check his BP?
    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?
 
 
 
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