Well, this flight was exciting, to say the least! Luckily it was a learning experience for both me and Matt! Whenever you have an airplane medical emergency doctors do have an ethical but no legal obligation to help. After this event, I thought it might be nice to do a dedicated video to Airplane Medical Emergencies and in general what is expected of doctors and passengers. If you're game for that please let me know in the comments!
Thanks, Defranco for the shoutout! Check out his channel here: https://www.youtube.com/philipdefranco
Link to Daily Mail article: https://www.dailymail.co.uk/health/article-7225235/Sexiest-doctor-alive-saves-life-flight-Israel-man-26-went-shock.html
If you have an idea of something you want me to cover in-depth, please let me know because I take your requests seriously. We will be back with more Doctor Reacts Series & Responding to Comments so please submit more names of shows/episodes & questions you'd like for me to watch. Love you all!
- Doctor Mike Varshavski
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- I wanna give a shout out to our BAMF of the day, the internet and YouTube's own Dr. Mike. - Passenger went into anaphylactic shock during a flight. - Thankfully, Dr. Mike was on board. - I think it's story time. (stirring music) (heart monitor beeping) I was headed to Israel to work with a nonprofit called America's Voices in Israel. They wanted me to meet some med tech CEOs, visit some hospitals, some nonprofits, visit with the university faculty and chat about their research. But the trip going there was quite eventful, to say the least. We're about two hours into the flight, we're over the Atlantic Ocean, and the flight attendants make that announcement. Is there a medical professional on board? I don't know why I'm holding a mic like this. They have phones. Is there a medical professional on board? The flight attendant's right next to me. I'm a doctor, I can help. I'm not wearing shoes. I have a hoodie on. And I look like I haven't slept in days because my strategy was to sleep on the plane going there to reset my circadian rhythm. The flight attendant does believe me that I'm a physician, brings me over, and I meet the passenger. He's a young guy, and he tells me that he's starting to have some swelling in his hands. And when I look at it, I see hives are present. So, he's having an allergic reaction. And he said he's had an allergic reaction the night prior, but it wasn't that bad. He took some Benadryl and it went away. Now, in that moment, I asked him if he had the allergy medication still on him, and he did. He had some steroid on him, Prednisone, and Benadryl. I instructed him to take another dose of both and to let me know if anything at all starts happening in his mouth or throat, because that could be a sign of anaphylaxis, which means that you have swelling of the upper airways, which essentially, if left untreated, can lead to death, and very, very quickly. Now, you might be wondering, what is giving Matt this serious anaphylactic reaction? He didn't eat on the plane. My suspicion, based on talking with him and hearing his history, he was eating a significant amount of red meat the night prior. Why is this interesting? He normally doesn't eat red meat. He also says not too long ago he was bitten by a tick. Now, if you're bitten by a specific tick called the lone star tick, which exists in the southernmost region of the United States but now is slowly creeping its way up north, you can develop an allergy to red meat, specifically to alpha-gal. This is a sugar molecule that's found in some mammals, but not people. And once you're bitten by this tick, if you eat an animal product that has alpha-gal in it, you can have a delayed allergic reaction much like Matt had. I right away started thinking worst-case scenarios. What's gonna happen if his throat starts swelling and we're over the Atlantic Ocean? Well, we can't land, so I would have to administer epinephrine, which is essentially just adrenaline. And we give this medicine into the upper thigh, into the muscle, in order to relax the airways, to tense up the blood vessels throughout the body so that we don't lose blood pressure, which is one of the really dangerous parts of anaphylactic shock. If the epinephrine or the EpiPen does not work, the next step would be to schedule a landing. And if the swelling continues to get worse, I would be forced to make an incision in this young man's throat. I started panicking. I haven't done this procedure since medical school. I haven't seen it performed in years. I tried connecting to the wifi to watch videos. I have no shame in saying this because this is not a procedure we do anymore. We intubate patients. But to do what we call a cric, that's serious stuff. That's what you see on Grey's Anatomy and House episodes that we laugh at and say, oh, no one ever does this. So, I was trying to brainstorm what I can use in terms of tools on the airplane to make this incision. I was saying maybe a pen, maybe a needle, maybe one of the ampules that were found in the kit that were made of glass, and I could use a sharp piece of glass. My mind was racing. A few minutes later, the flight attendant comes and gets me and says, "Okay, he's starting to have oral symptoms." And that's when I kick into my medical mode, full-on medical mode. I rush over, I look at his throat. It is definitely swelling. I can see it swelling. I just make the decision to rush him to the front of the plane, right by the cockpit, and it allows us to get some privacy, 'cause I was gonna ask him to take off his pants in order to give him the injection. When I break open the kit that was found on Delta's plane, I was shocked because on the outside of the kit, it said epinephrine. There were no EpiPens. Now, you might be thinking, well, if there's epinephrine, what's the big deal? You have epinephrine. It can be used just like an EpiPen. Well, yes and no. While it's the same active ingredient, the dosages are different. Normally you give either .3 milligrams or .5 milligrams during an anaphylactic reaction. With an EpiPen, that's already pre-administered and pre-filled with the needle in it and everything. Now, what was in Delta's kit was an epinephrine injection kit for cardiac arrest. That's when someone's heart flat-lines. You're not shocking a patient. You're giving them this dose of epinephrine. This is much higher dose. It's one milligram. And the needle is an inch and a half long. And I knew this was gonna be painful. So, here I am reading the instructions on how to get the needle free, because this isn't a kit I was familiar with using. So, I was fumbling with it for the first 30 seconds or so. That's why we need to have an EpiPen on board. Because an EpiPen, had it been there, all you have to do is read the instructions really quickly, boom, it auto-injects. It's simple. I told the patient what we're gonna do, I guess the passenger, told the flight attendant, and I injected it because his throat was really starting to swell. He started screaming. I immediately withdraw the needle. I hand him an alcohol pad and I ask him to hold pressure so I didn't get any of his blood on me. He starts telling me that the area's becoming very tender, and I understand why. One of the main mechanisms of action of how epinephrine works is vasal constriction. It makes the arteries clamp down. That raises the blood pressure and allows the person to live. But also, if you're giving it in this area and it tightens all the blood vessels up in this area, it causes a lot of pain. So, right away I explained to him what was going on. I had him take a few steps to walk around, got some ice on his leg just to make the pain a little bit less. We're checking his pulses, checking his vitals. The reason why when you administer epinephrine or an EpiPen the first step we do afterwards is to get you to a hospital is for monitoring, to make sure that, A, the allergic reaction doesn't come back, B, to make sure that your heart is okay because I'm giving you adrenaline. That not only speeds up the heart, raises the blood pressure. It can cause all sorts of side effects. So, now above the Atlantic Ocean, the pilots are asking me, the flight attendants are asking me, should we land in Canada? Should we go back? Should we land on the islands near Portugal? I ask the head flight attendant, who was super sweet, to ask ground control what their policy was. And what she told me Delta told her, as long as a doctor was in control of the situation and felt the patient was stable, no emergency diversion was needed. So, I checked his vitals a few times after doing the injection. He was tachycardic as a result of the epinephrine. His blood pressure was stable. It was in the normal range. It wasn't dropping. And we made the decision to continue on route to Tel Aviv, Israel, but continually monitoring his status. I took out my iPhone. I was looking in his throat just to make sure it wasn't swelling. Because he did scare me a couple of times. He couldn't tell if it was just very dry or starting to swell. Whenever you get a dose of adrenaline, I guess think about if you're making a speech and you're doing public speaking. You get nervous, you get dry mouth. That's the adrenaline kicking in there. So I thought that that's what likely was going on because when I looked with my iPhone, I did not see any swelling. Everything looked okay. There was no need to give a second injection. So, what my job was once we gave the injection was to, A, keep the patient calm, and to check his vitals to make sure there's nothing bad changing, his blood pressure wasn't dropping, his pulse wasn't going too high, and we could continue on with our flight. I did this pretty much every 30 minutes, talked to him, stood over him. And at one point, he became really tired because he took several doses of Benadryl, Prednisone, adrenaline. He was getting sleepy 'cause he didn't sleep well the night before. So, after watching him for about four or five hours after the injection, I felt comfortable returning him to his seat, telling his counselors and people that he was on the trip with about what was going on, that if anything were to change to right away come and get me. But my plan was to put him in his seat for the last two hours and every half hour or so come on and check on him and do another round of vitals. I did that up until the point of landing. His vitals were great. He was resting, his throat wasn't swelling, his pain in his leg was even resolving. So, we're able to land the plane and he survived this transatlantic flight. The passengers around me thanked me, but they didn't thank me for saving this young man's life. I gues...