In-Flight Emergencies REBOOT with Angelica Zen MD

October 7, 2019 | By Matthew Watto, MD

Dominate the most common in-flight emergencies

Dominate the most common in-flight emergencies with tools and tips from this classic Curbsiders episode. Our guest, Angelica Zen MD, (formerly an IM Chief Resident at UCLA), recounts a harrowing tale of heroism at 30,000 feet and schools us on how to throw down in an in-flight emergency. We review what’s available in the standard medical kit, common conditions encountered, and the medical legal implications of responding to in-flight emergencies. This episode is a must listen before you next step on a plane. Original air date November 21, 2016.

Credits

Written, produced and edited by: Matthew Watto MD, FACP

Cover Art by: Matthew Watto MD, FACP

Hosts: Stuart Brigham MD; Paul Williams MD, FACP; Matthew Watto MD, FACP

Guest: Angelica Zen MD

Partners

Win a prize! Celebrate National Internal Medicine Day and tell us why you’re I.M. Proud.

Tell us why you are I.M. Proud and enter the contest by visiting acponline.org/improud to submit your story today! Answer one of the three questions below and share your story on social media using the hashtags #IMProud #NationalInternalMedicineDay, and tag @acpinternists. Prizes will be given out 3 times through June of 2020. The first group of winners will be announced on the first ever National Internal Medicine Day October 28, 2019!

1. What makes you proud to practice internal medicine or one of the I.M. subspecialties? 
2. What recent patient experience made you proud to be an internist or subspecialist?
3. How is internal medicine unique from other subspecialties?

See us at the CHEST 2019 Annual Meeting in New Orleans!

We’ll be doing two live interviews on stage, plus recording two recap episodes to bring you high yield clinical pearls from the conference. Look out for us in our red Curbsiders shirts and say hello. Take a picture with Stuart! Give Paul a hug! Register today https://chestmeeting.chestnet.org/ !!!!

Time Stamps

• 00:00 Cold open; Disclaimer
• 00:50 Sponsor: ACP’s National Internal Medicine Day 2019 www.acponline.org/improud 
• 01:10 Intro, Guest Bio
• 02:50 Guest onliner; Wellness tips; Tips for staying up on the literature
• Pick of the Week*: How Doctors Think (book) by Jerome Groopman; MDCalc app; AHRQ app; Physician’s First Watch
• 07:30 Sponsor: ACP’s National Internal Medicine Day 2019 www.acponline.org/improud 
• 09:08 Dr. Zen tells her story
• 19:27 Monitoring your patient in-flight
• 20:05 Contents of the standard in-flight medical kit
• 22:10 What Dr. Zen would have done differently
• 23:05 How to use available resources in-flight
• 24:20 Medical legal implications
• 28:07 How to respond to common in-flight emergencies and how to respond
• 29:35 Syncope and presyncope
• 31:55 Hypoxia altitude simulation test (HAST)
• 33:15 Altered mental status
• 33:52 Anaphylaxis
• 35:34 Stroke and acute coronary syndrome
• 36:55 Dr. Zen’s take home points
• 38:50 Outro

In-Flight Emergency Pearls

1. Stay Calm!  If you freak out, so will everyone else.
2. Think outside the box and be prepared to improvise from available resources. (e.g. ask another passenger for a glucometer)
3. Standard medical kit contains – manual BP cuff, stethoscope (cheap), gloves, oropharyngeal airways, CPR masks, bag-valve masks, IV set, 500 ml saline, needles, syringes, analgesic tabs, antihistamine (tabs or injection), aspirin, atropine, inhaler (bronchodilator), Dextrose 50%, Epi (1:1000 and 1:10000), IV lidocaine, nitroglycerin tabs, supplemental oxygen.
4. Don’t forget to utilize the ground medical team!
5. Legal repercussions very unlikely unless there is “gross neglect” or “intentional harm”. DON’T treat patients if YOU’VE BEEN DRINKING!
6. Common emergencies in order of decreasing frequency – syncope and presyncope, dyspnea, acute coronary syndrome, altered mental status, psychiatric emergencies, stroke, cardiac arrest

Goal

Listeners will comprehend their role and potential liabilities during in-flight emergencies and effectively utilize available resources for triage, patient care, and decisions about diverting the plane.

Learning objectives

By the end of this podcast listeners will:

1. Be familiar with the contents of the standard medical kit
2. Think outside the box to identify, improvise and utilize the available resources for patient care
3. Recognize the medical legal consequences of providing emergency medical care on a plane
4. Confidently evaluate and manage common in-flight emergencies using the available resources

Disclosures

Dr. Zen reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.

Links*

1. How Doctors Think (book) by Jerome Groopman 
2. MDCalc app 
3. AHRQ app – Plug in the patients demographics to get evidence based screening recommendations.
4. Physician’s First Watch – short daily emails summarizing key articles from various journals
5. Baby delivered in-flight by Angelica Zen, MD http://newsroom.ucla.edu/stories/
6. Great review article on In-Flight Emergencies. Nable JV, Tupe CL, Gehle BD, Brady WJ.  In-Flight Medical Emergencies during Commercial Travel. N Engl J Med. 2015 Sep 3;373(10):939-45. doi: 10.1056/NEJMra1409213.
7. Article on the hypoxia (or high) altitude simulation test (HAST) https://www.ncbi.nlm.nih.gov/pubmed/18398121
8. Interesting article: Passenger safely defibrillated 21 times during International Flight. Harve H1, Hämäläinen O, Kurola J, Silfvast T. AED use in a passenger during a long-haul flight: repeated defibrillation with a successful outcome. Aviat Space Environ Med. 2009 Apr;80(4):405-8. 

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Citation

Zen A, Brigham SK, Williams PN, Watto MF. “#19 In-Flight Emergencies.” The Curbsiders Internal Medicine Podcast http://thecurbsiders.com/episode-list. Original air date November 21, 2016.