Cardiac arrest at 40000 feet

[Just Plain Ruff]

You are flying from Tampa to Houston on a 2 hour flight.

The flight attendants broadcast overhead the need for a medical person.

You answer the call(and you are the only one to do so) and are whisked nearly to the back of the plane to a small frail elderly man sitting in his chair in obvious distress. He's got that fixin to die look

You meet the patient and talk to him. He has that thousand mile stare that we all have seen.

He then slumps over in the chair requiring you to hold him up.

What do you do?

[JTpaintball70]

First, what do we have available? But if I see him fall out, let him down to the floor, check pulse.

[Just Plain Ruff]

First, what do we have available? But if I see him fall out, let him down to the floor, check pulse.

Ok, the ALS kit the airlines have consist of some good stuff. The airline kit that we will use will have the following

1. AED

2. IV bag of NS(500ML) and 1 iv cath of each size 18, 20, 22, and 24

3. Epi 1:10000 (1mg x 2 amps)

4. Atropine same 2 amps

5. lidocaine same 2 amps

6. many other non-als (code) drugs

7. they have 5 oxygen tanks (the small ones)

8. non rebreather mask, bag valve mask and cannula

9. Other items that I can't remember right off the top of my head.

That's your kit.

The guy slumps over and you help him to the floor and he has a very very weak pulse at about 30. He is not breathing

I am heading off to the Eagles Concert in Orlando. I will re-visit this topic tomorrow

[spenac]

Get someone with CPR training to help, usually the stewardess have that training.

O2 via BVM.

Is 30 and weak pulse at wrist or neck?

Check for DNR.

Any bleeding?

Does chest rise with BVM?

Any hives or other to indicate possible allergic reaction?

Establish IV preferably 2 but doesn't look like you have a lock or another IV set up.

Attach pads. Is AED type that will display EKG? If so what does it show.

Go ahead and prepare your ACLS drugs as looks like you will be working if no DNR.

[Chief1C]

How long till you can land?

[fakingpatience]

Let me take a stab at this from my BLS education (aka, I don't know much about the drugs)

.

Once you start ventilating the pt, have someone find someone who knows the pt, get a history, as someone else said, make sure no DNR, ask about other meds... Any other s/s of a problem, diaphoretic, wheezing prior to losing respiration, hives, trauma...? Any medical bracelet? Have someone check pt's carry on for meds they are carrying. Start an 18 G in one arm, and a 20 in the other if you can hook up two IVs/ have access to a saline lock.

Reassess vitals. Pulse? Strong, weak, regular, or not... where can you palp it (to get a general idea of the BP). Get the AED hooked up to the pt, so you don't need to worry about it later.

Find more people who can do CPR... once this guy goes down for the count, you could be doing it for a while. However, I don't think I would ask specifically over the intercom for someone who knows CPR. On a plane, you need to consider the potential for an MCI if you cause panic. I would probably try and bring the pt into the back flight attendant area (if feasible, and doesn't compromise care), just so that it is not in front of the entire plane.

And I am confused, you said the plane had many other non-als code drugs... aren't all the code drugs ALS?

[uglyEMT]

Let me take a stab at this from my holy crap Im only BLS perspective

Slumps over? Get him on the floor preferably away from onlookers

OK non ALS drugs? Is it asprin? If so have it on stand-by if we get him back and he can swallow.

Have stewardess get the pads on him while I secure airway. Does he have a gag reflex? If so, nasal him.

Get an O2 tank and start bagging him.

Check for medic alert tags. Have stewardess see if he has a travel companion and also check for his carry on.

While bagging ask the stewardess to see if anyone else, including flight crew, has CPR training, if we start it might be awhile.

Have stewardess notify the pilot of the situation, see if he can divert to the nearest airport and have medics on stanby for arrival.

Keep bagging, change O2 tank as necessary.

Check pulse again, still there? Still at 30?

Keep Bagging.

until we hear the next phase I will sit here patiently awaiting info and keep baggin and switching tanks LOL

Edited October 8, 2010 by UGLyEMT

[Just Plain Ruff]

Guy has no DNR or any family travelling with him so theres no help there.

Non ALS Drugs - I meant to say that there are other drugs in there but they include the likes of dramamine and benadryl

The kit you are using does not have the capability of starting two iv's to run fluids. Maybe a lock but are you sure you want to do that?

The flight attendants at this airline by policy are the ones who operate the AED - so they put the patches on.

You are bagging the patient but there is no nasal airway

Patient still not breathing and pulse is now Gone. You start CPR

Pilot declares medical emergency and the two airports closest to you that can accomodate a 757 are New Orleans - 45 mins away

and houston 1 hour away. Either which way you are going to be in the air for 45 more minutes.

You are in contact with the Airlines medical control which so happens to be a Hospital in New York City.

You have no cardiac monitor other than the AED. The AED is a basic one, one of those idiot proof AED's.

What now.

[ERDoc]

What we should have done was get our drink on as soon as the flight started, then we could avoid this whole situation. Since we missed that opportunity we need to start working the guy. I wouldn't divert the plane just yet. Let's work this guy through a few rounds of drugs and see where we are at that point. If we have no pulse, confir with the medical control and pronounce. Continue on to the final destination and let the airline handle the body however they are supposed to. If we are able to get a pulse back, then divert the plane and hope he doesn't code again. Diverting a plane is no small decision. There are far reaching affects that the airline has to consider. If you have someone that you are going to work for 45 minutes while you divert, there is no benfit in diverting as this person is not going to make it.

[uglyEMT]

OK pulse no gone. Fun times ahead

Get that airway patent. No nasal airway so go oral.

Being its a witnessed arrest go staright to the AED. Is it shockable?

OK medical emergency declared already.

Start the compressions have them bag. If they know CPR have them start you bag and be ready on the next cycle.

Like I said I am BLS so drugs are out for me unless Med Control authorizes me.

Go New Orleans, 45 is better than 1 hr. Have medics waiting.

Honestly, in my opinion, I would have the stewardess ask if anyone knows CPR. Your going to need a few people on this one.

What is the AED syaing? Is the rythem shockable yet?

keep pumping and baggin its going to be a LOOOOOONG flight.

as a side note: I did read you had epi. If med control allows me I would get the epi in it might help (if its an autoinjector even better for me, inside my SOP). I know about the other drugs as I have seen them pushed but again I am BLS so unless med cont authorizes it I am going nowhere near it.