You forgot the ringers lactate! Great job, you killed her and made everyone late.
Heh!
If he hasn’t seen this by the time he gets home, I’ll point him toward it.
Edwino, I’m curious about the drill the airlines go through in this situation. I wouldn’t be surprised if on the average flight, the closest they could get to a medical professional would be a pharmaceutical salesman. Would they immediately land in that case as a precaution? And do you have a professional obligation, as opposited to a humanitarian one, to help out? Is this something they talk about in medical school? I imagine the situations are legion where you’d be called on to provide some emergency help.
And by the way, I agree with those who say the airline ought to offer you something nice as a reward. Maybe let you fly the plane a bit.
She must have had the fish…
If you don’t mind a critique from a paramedic, it sounds like you did a good job. I came up with the same working diagnosis based on the history you provided. Was there a glucometer in the first aid kit? I probably would have checked her sugar even though she’s not diabetic. Hypoglycemia can and will mimic a CVA and makes some paramedics look silly a lot more often than it should.
I know how you feel about the lack of follow-up, too. It’s like pulling teeth to get info out of some of our local hospitals.
St. Urho
Paramedic
Sorry, another question. Wouldn’t aspirin be just the thing to NOT give her if she’s having a stroke, on the chance that it could be a hemorrhagic stroke?
Thank you…I was going to be disappointed if no one else had gone there. 
One more kudos to you, edwino, on a job well done.
I’d just like to applaud you especially for this: knowing when not to act is important.
I meant to add that to my post- aspirin is not indicated for acute CVA for that reason. You can suspect one or the other, but there’s no way to be sure until after a CT has been done.
Whoops, looks like you got the wrong one, PS. 
Here’s another “attaboy,” doc. Well done.
And, don’t let your “inexperience” bug ya. Hell, I’ve seen Radiologists with 30+ years of practice get pretty hinky when a patient crashes unexpectedly. I’m really glad the ER is next door.
(Also, you forgot to order “AP and lat C-spine and chest pictures, stat!”)
Two thumbs up.
In that situation, the only decent choice was to divert and get her to an ER for evaluation. And if she’s fine, so what? The only way to rule out a serious problem in a person with a history of serious problems and symptoms of serious problems is to send her to a serious problem analysis site, a nearby ER.
And if you’re not pissing somebody off with your decisions, you’re not practicing good medicine!
It bodes well for your future career as a physician.
Very interesting story, Edwino. Being diverted due to a medical emergency sucks, but it ALWAYS sucks more for the patient.
Good thing I had the lasagna. You know, sitting there for over an hour with her, I considered starting the conversation with the flight attendant
Me: We need to get this woman to a hospital!
Attendant: A hospital?!? What is it?
Me: It’s a big building filled with sick people, but that’s not important right now.
My wife asked how they knew I was a medical student, and I told her it was because I had my stethoscope in my ears.
They haven’t broached this issue (liability issues when rendering aid) in medical school recently. I took ethics in 1999 – it was interesting back then, but I don’t remember that much. I think, unless something goes drastically wrong and you are limiting your actual intervention, you are usually covered by Good Samaritan rules. Although, I’m sure it is state-dependent. IIRC, QtM and I are in the same state – Qadgop is that a question you can answer?
I of course have malpractice coverage through the school. But I couldn’t morally sit there and do nothing, and I am well aware of my limitations (and I always hope that I will be), so I’m very honest about my situation and if they still need me, they come for me. It was the same during Hurricane Katrina – I couldn’t sit there and do nothing, and the medical societies were crying for people to work overnight, so I showed up.
I don’t know the answer to the usual airline procedure. Luckily, these automatic external defibrillators will do a pretty good job – they diagnose a shockable rhythm, decide how to shock, give instructions, and shock. Shocking works great when it works, but unlike the TV, it isn’t done for everything (like asystole – the typical “flatline” – is not shockable). So if something very serious happens (major MI with loss of pulse), unless there is someone who can establish an airway and IV access, I think you are stuck with chest compressions until you can get on the ground. The mortality rate for that, just like if you are in a rural house and 911 takes 30 minutes to show up, is very high.
If someone there can get IV access (or even an airway for epinephrine), they have some basic code equipment and I would expect it to get very involved very quickly. It would not be pretty, not at all.
Well, since Qadgop has mentioned it on the boards before, I see no harm in repeating it - he lives in southeastern Wisconsin.
Hmm, some MD on the board lived outside San Antonio. Don’t remember who.
I have a number of friends who have gone through residency and I am sure they would agree that you did well here.
The only surprise to me is that the airline did not divert sooner. Perhaps with the flight plan this was the best option, but my cynical side wonders if they were hoping that you two would be enough to get this lady through without a diversion thus saving all the headaches for them that you describe.
As far as I can tell, in both cases your patients were better off than when you got there and you did no harm to them - hey, that’s better than happens a lot of the time in medicine.
As for the passengers, they could have faced a nut with a fruitcake.
Three cheers!
If I’m wrong on any of the following maybe one of the Big Iron guys can correct me.
Diverting an airliner isn’t instantaneous. No doubt while edwino was doing his work up the pilots were informing ATC of a possible medical emergency and trying to decide where would be appropriate to divert. First of all, they have to find the nearest airfield that can accomodate the plane. Fortunately, a 737 can handle a fairly short runway for a passenger jet when necessary (and assuming it’s not 10 inches of snow on the south side of Chicago, like that recent mishap) - if they were in, say, a 747 there would be fewer options because a of airports just can’t handle a plane that size.
Once they get a suitable divert-to choice made they’ll probably check on what’s going on back in the passenger cabin to determine if it’s really necessary to inconvenience a whole bunch o’ people.
If yes, the pilots then get back to ATC and say yes, we need to divert and go here because we have a medical emergency. ATC then needs to clear a path to that airport, after which the jet (assuming you’re starting at cruise) is going to take at least 30 minutes to get where it’s going. Which is one reason it’s a Bad Thing to have a genuine emergency at 30,000 feet - you’re at least 30 minutes from the ambulance, never mind the ER.
The pilots might have started to divert before the flight attendant made her announcement about going to El Paso. Airlines don’t like diversions, but dead passengers can also have unpleasent consequences.
Nice job edwino. Best of luck in your career; you’ll be one of the better ones.
I concur, and obviously from a lack of knowledge in all things medical, I think it sounded astoundingly thorough! The world needs more docs like you, instead of the pompous asses that prance around the hospital corridors ignoring the rest of the staff.