Is there a Physician on the Plane?

This article originally appeared online at Dr.Pullen.com, part of the HCPLive network.

As I sit crossing the country on a ride home from visiting my family in Maine, I remember back on a similar flight a few years ago. Most physicians who have travelled much probably have their own stories to tell about being called to service on airline flights. My most memorable flight was on a transcontinental flight when I was asked to help not one, but two separate elderly passengers. Unlike most of the times when I’ve been asked to see a passenger, both of these passengers really needed some help, and presented modest challenges.

The first passenger I was asked to see was an elderly woman who was having some angina. She had what sounded like stable angina, and had one fairly brief 3-5 minute episode of angina that was relieved by a single sublingual nitroglycerine tablet. Her vital signs were fine, and the “emergency” was that the flight crew needed to know if we needed to land at the nearest airport. The passenger had asked for help getting her nitro pills from her bag in the overhead compartment, and so the flight attendant was involved. She was mostly embarrassed that she was the center of attention, and I felt comfortable after a history and very brief physical exam advising them that we could fly to the original destination.

Almost before I finished with that passenger another elderly woman sitting near the back of the plane complained of shortness of breath. At a glance she was a classic “pink puffer.” This is a patient with a type of chronic obstructive lung disease called emphysema. She was extremely anxious, but her color was good, her pulse only about 90, and her BP was fine. There was no pulse oxymetry available on the plane, but her lungs were clear (they did have a stethoscope) and after talking for a few minutes her shortness of breath improved. The flight attendants really wanted to give her oxygen, but there was no flow regulated oxygen available, just essentially 100% oxygen with a mask. I was concerned that using a high concentration of oxygen might lead to loss of her hypoxic drive to breath, and lead to progressive carbon dioxide retention.

We had several hours to go before landing, and so I just sat with this woman for the rest of the flight and kept her calm. I am no respiratory therapist, but simple pursed lip breathing and hand holding seemed to help her enough to keep her calm and comfortable. She did fine. I did feel like she should be evaluated at an ER when we got to our destination, and the flight crew arranged for her to be met at the gate. They had no problem arranging that. They were very concerned that since she was at the back of the plane, they were going to have to hold everyone on the flight until the paramedics could come get her out. I suggested that we have her move to the front of the plane prior to landing. The flight crew had not thought of that, and so I asked a couple in their early 20’s in the front seat to change seats with us. Remarkably they complained that they needed the front seats for more leg space because of a bad back condition and they refused to move, but another couple agreed, and all ended nicely. I was surprised that there was not an oxygen flow regulator available on the plane. I did find out that they did have an AED and IV fluids available.

Ed Pullen, MD, is a board-certified family physician practicing in Puyallup, WA. He blogs at DrPullen.com — A Medical Bog for the Informed Patient.