MAR 06-5

JPingul’s Medical Anecdotal Report 06-05
Date of Medical Observation: May 19, 2006
TITLE: Emergency in the Sky


Narration

It was 1 o'clock AM, I was trying to get some sleep, along with the other passengers, inside the small space that was allotted to economy class passengers aboard Philippine Airlines. It was quiet and peaceful. The stillness of the cabin was interrupted by the stewardess, who paged on the speakers, that they were in immediate need of a doctor.

I was hesitant at first, feeling around if there were others who would respond. A few seconds passed and there seemed to be no one, so I got up from my seat and called the attention of the stewardess. I asked her what the problem was and she answered that a passenger had chest tightness and difficulty of breathing.

As I entered the cabin for first class, I noticed a week looking passenger seated on one of the chairs used by the crew. She was cold and clammy, and when asked what she as feeling, barely spoke and signaled only to her chest and neck area, as she tried to breath in air heavily.

I motioned to the stewardess that we needed her to be lying down and asked if they had any stethoscope and sphygmomanometer. As one steward got the first aid kit, the other two assisted the patient to a vacant first class chair and reclined it to the full.

I asked for her past medical history, any medications being taken, it was unremarkable except for a blood chemistry done previously that indicated high cholesterol levels. I also asked where she was seated and if she skipped any meals.

At the same time I counted her pulses, and looked into her conjunctiva if there was any pallor. When I placed the BP apparatus to get her blood pressure, I was not able to appreciate anything, I checked again and tapped the steth diaphragm if it was functioning. Was I just sleepy or was it the ambient air craft noise or was the patient in palpatory? I focused on the lower markings, 80/60.

My diagnosis was orthostatic hypotension, so I elevated her legs, and asked for O2 support if there was any. In an instant there was and I was asked if it was 10, 4, or 2, these were the only preset calibration. So I answered 4 Lpm.

After 5 minutes, I measured her blood pressure again, and this was able to hear distinct beats between 110 and 70. The patient also gestured that she was feeling better in her present position.

I told her to maintain this position for 30 minutes and will come back for another BP. I was asked by the head steward on the cause of the symptoms and I told her that I could have been caused by prolonged standing or sitting position at the airport or inside the plane.

I got back to my chair and updated my wife on what had happened, and the steward asked me to fill up an emergency medical form. She took my address and contact number, and asked if I needed anything, a drink or food to eat? I told her that I wanted a bottle of water, which she readily gave.

From then on, the patient was feeling fine, and eventually returned to her original seat.

As we reached or destination, and the passengers started to move out, I caught eye of the patient from a far, and she gestured a thank you with her mouth and I replied with a welcomed smile

INSIGHTS: (discovery, stimulus, REINFORCEMENT), (physical, PSYCHOSOCIAL, ethical)

My residency training in trauma has taught me to be assertive when it comes to patients seeking emergency medical help. Since I have been used to giving charity medical care, I did not care if she was poor or not. Time did not become a factor, if I was sleepy, I forced myself to wake up. The place did not become a factor too. My concern was, if she needed help, I was here to offer my services and knowledge.

Although it is my profession to give medical care, giving value to life has been a vocation, hence it did not matter who, when or where, as long as there is an emergency I am here to volunteer my skills. I do not intend to be a superhero, in fact, even the simplest and most ordinary things may mean a lot to the person in need of help.