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Jimbo
07-08-2004, 13:30
So...say you're on a plane. Its been on the runway for 40 minutes. The APU is down so there is no AC. Temperature climbs into the high uncomfortables. Flight attendant comes over the PA and asks if there are any medically trained people on board. You are the only person to identify yourself. She tells you that there is a young woman who is clausterphobic and another young woman who has asthma. The asthmatic is not having any problems...yet, but does not have an inhaler and does not know what kind of asthma she has. The clausterphobe is not presenting either, but the flight attendant wants to know what to do to make the two more comfortable and what to do if either has an attack.

What do you tell her?

shadowflyer
07-08-2004, 14:06
Hmm good one Jimbo.

Lets see.

PT 1 Claustrophobe--TX Keep her calm, if possible open one of the side doors if the engines are not running, if the engines are running then we would have A/C regardless of wheter or not the APU was operable. Engines will have enough bleed air to run the A/C system. PT will need to feel like they are "open" persey vs closed in. Main thing is keep her calm. If 02 is available , 15L 02 NRB mask if tolerable would help ease her worries a bit. NC 02 if she cant tolerate the mask.




PT 2 Asthmatic--TX Keep her calm. POC. Inhaler would help if she goes into Asthma attack. Bronchodilator will be a BIG help. If 02 is available, 15lpm O2 NRB if she goes into distress at all.



Just my thoughts. Any Airway bag/kit on board? Trauma Kit on board. I hope they have a AED.

Jimbo
07-08-2004, 14:30
There was O2 on board, but no airway kit nor trauma kit. I was not aware if there was an AED on board or not.

The flight attendant was unwilling or unable to open the hatch. The engines were running but there was still no A/C. I think its like idle vs. full gas and the A/C in your car.

Luckily, the situation did not go south. The plane got airborne within 15 minutes.

I did not reccommend giving O2 to the clausterphobe because if the Asthmatic went bad, I wanted to have as much on hand as possible. I asked the flight attendant to have the clausterphobe sit in the jump seat because there was a fan in the galley that would blow on her and she wold be able to see that she was in a larger space than she may have though while in her seat.

The Reaper
07-08-2004, 15:00
Most a/c have Valium on board in the med kit, IIRC.

TR

Jimbo
07-08-2004, 15:03
Originally posted by The Reaper
Most a/c have Valium on board in the med kit, IIRC.

TR

As a lowly EMT, I would not have been allowed to administer that to her. An EMT can't administer meds, but they can assist a patient self-sdminister some meds.

Ambush Master
07-08-2004, 15:05
This had better be a Part 91 Operation and not 135 or 121, because since the mid-80's there has to be an emer med kit on board and there are 2 airways in them !! Also, diphenhydramine HCL , epi, dextrose and various means to inject !!

Sacamuelas
07-08-2004, 15:09
The claustrophobic patient:
check the patient first...
I would not give o2 via NRB prophylactically just because they have a Hx of claustrophobia. Many anxiety disorder patients exhibit hyperventilation as a symptom leading up to and during an episode. Giving 02 to an already hyperventilating pt via a nonrebreather would be counter-productive. So check your patient for this before this Tx.

When hyperventilating, Patients tend to breathe by using the upper thorax rather than the diaphragm, which results in chronic over inflated lungs. When the stress induces a need to take a deep breath, the deep breathing is perceived as dyspnea. The sensation of dyspnea creates anxiety, which encourages more deep breathing, and a vicious cycle is created.

To treat, instruct the patient to breathe abdominally, using the diaphragm more than the chest wall. This often leads to improvement in 'subjective' or patient perceived dyspnea and eventually corrects many of the associated symptoms.

Otherwise, I would calm the patient, put in a comfortable position, tell the FA to see about activating her protocol for giving the passenger a sedative ( short acting benzo if available). I would imagine major airlines have a med kit on teh plane with sedatives as well as a protocol for their use. I would not put my Butt on the line prescribing or telling a FA to give a medication, especially in a non emergency case such as this. No caffeine or other stimulants for the patient during the flight.

The asthma patient:
My guess is that the plane's med kit has an inhaler ( probably albuterol). Tell the FA to go and visually check for its existence. If available, give patient prophylactic dose to inhale after quick med hx. Again, place pt in low stress environment ( as low as possible)... oxygen is good to calm patient if feeling symptoms of dyspnea. Usually want to place patient in a comfortable environment avoiding HOT/MOIST air and Cold/dry air environments. Also have patient avoid caffeine, as it is a common trigger for asthma attacks.
If an asthma attack actually would have occurred-
02 immediately. If no inhaler available, ask patient to notify of any oncoming attack asap ( if they can tell, they usually can) and in an emergency the planes epi pen can be used to bronchodilate to stop the attack. During a severe attack, I would have asked the FA to announce over the PA to see if a passenger on board had an inhaler with them.

That’s my .02....
:munchin

Jimbo
07-08-2004, 15:12
Originally posted by Ambush Master
This had better be a Part 91 Operation and not 135 or 121, because since the mid-80's there has to be an emer med kit on board and there are 2 airways in them !! Also, diphenhydramine HCL , epi, dextrose and various means to inject !!

I was not made aware of any kits on the plane. However, I never asked. The one patient that was feeling at all off was responding well to the seat change and fan. When I was approached by the flight attendant, I was told about the two patients. I asked if the Asthmatic had her inhaler. The flight attendant told me "No. But I have oxygen." That was the extent of it. Had things gotten worse, I would have requested that we taxi back to the terminal. Had things gotten bad fast, I hope the stewardess would ahve mentioned having a med kit on board. Thanks for the reminder and the heads up that the plane should have that equip, I will make a note to remember to ask what's on hand.

This was one of the new budget airlines. I have no idea if they were up to regs or not.

Ambush Master
07-08-2004, 16:01
Here's a link to the page that describes the contents, also the epi is what is carried for asthma :

http://dmses.dot.gov/docimages/pdf47/80979_web.pdf

It's on the third page center column.

Jimbo
07-08-2004, 16:16
Much appreciated.