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    ummm....get as much info out of him as possible regarding other medications, medical history and continue to take obs. Keep him on the oxygen and be as reassuring as possible. I guess really you want to prepare yourself as much as possible for if he stops breathing, and I guess that on a plane you can't have a defib(?) so you want to know what those other medications in the box are. So contact someone who can identify the meds. Tell the pilot they need to land as soon as possible.
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    Get the pilot to divert the flight. I'm not sure exactly how this works or where to, but that's their job. Get them to have medical assistance ready - again, I'm pretty sure the airline will have a policy in place for this; I can speak to the medical team if needed but the airline are the ones who need to get things rolling.

    Edit: I'm pretty sure all planes have to have a defib on board.
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    (Original post by electricjon)
    You give him 300mg of out-of-date aspirin.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?
    Wait about and hope he stabilises. Keep checking with the stethoscope for any irregularities in his heart sounds?
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    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?"
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    (Original post by Helenia)
    I'm pretty sure all planes have to have a defib on board.
    International laws don't require passenger aircraft to carry emergency medical equipment on board, including defibrillators. All major airlines (e.g. BA, Virgin) will always have them on board their planes, but the airline in this scenario doesn't.
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    (Original post by electricjon)
    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.
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    (Original post by Beska)
    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 that 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?"
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    (Original post by electricjon)
    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?"
    That's the limit of my personal knowledge. :p: I know buttloads about GMC guidelines but **** all about actual medicine. Prefresher for you, ha.
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    (Original post by electricjon)
    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?"
    Turn the plane around. They guy is going to need an ECG soon to see any damage and maybe an ultrasound. You need to err on the side of caution
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    I'd ask the pilot to divert back to NY. It's a he'll of a long flight back to the UK and I wouldn't want to risk it. Plus I'm not sure, but wouldn't you need to confirm the diagnosis with trop tests, or are you 100% certain it's an MI? Is there anything else that presents like an MI?
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    Whatever else happens, I'm never flying with this airline again :p:
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    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!
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    (Original post by nexttime)
    Basically, if you were chinese he would love you!
    bc of having some different enzymes?
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    (Original post by nexttime)
    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!
    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!
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    (Original post by No Future)
    bc of having some different enzymes?
    Chinese people have different ADH type yes - that is why they respond strongly to alcohol (going red etc)
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    (Original post by nexttime)
    Chinese people have different ADH type yes - that is why they respond strongly to alcohol (going red etc)
    Yep, indeed.

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

    Ok nevermind, I didn't see ADH in your post.

    Didn't read it properly!
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    (Original post by electricjon)
    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!
    I'm not sure how its works (i don't think anyone does) - all i know is that it reduces ischemic damage in dogs (and by a lot)!

    I'm just not sure what the downsides are - potential gain outweighs the loss and all that.

    And in medieval times, blood letting was used for a lot of things!

    EDIT: should say it works if you do it half an hour before an ischemic episode and also during.
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    This thread is bloody brilliant!
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    (Original post by No Future)
    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.
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    (Original post by nexttime)
    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.
    eta: sorry, I didn't read your post properly

    Any results?
 
 
 

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