“Is there any doctors or nurses on board this flight? Please
identify yourself to a member of crew. We need your assistant.”
On route back to Malaysia, on the Malaysian Airline,
I just had my dinner when this announcement was made.
I stood up and walk towards the air stewardess. She brought
me to the front of the aircraft and introduced me to an older man. His wife was
lying by his side and was in obvious distress.
As usual, I introduce myself, and then I went nearer to the
lady to ask her how I could help.
“I am having chest pain!” My heart sank… Chest pain in a 60+ year old person is
Myocardial Infarction (MI, Heart Attack) until proven otherwise. And we were 30
000 feet above sea level, 10 hours from landing.
I composed myself and ask further questions. It is not easy
as I have been a paediatric
doctor for the past 2 years. Luckily I was a houseman in the cardiology
department, and had the experience of attending out of hospital cardiac
emergency.
Chest pain, sudden onset on exertion, radiating to the left
arm, lasted for more than an hour, associated with nausea and light headedness.
No SOB. 60+ year old, history of hyperlipidemia on statin. Previous history of
heart burn, but this pain is not like the usual heart burn sensation.
The lady looks pale and clammy; looks really unwell.
Systemic examination, no abnormality found. BP 140/85. Regular pulse, 80.
Having the above history and examination, I was really
worried that the patient had acute coronary syndrome. Unfortunately without ECG
and cardiac enzymes, I could not diagnose MI.
By this time, the chief steward had brought me the physician
emergency kit. I could not even find an aspirin in the box! I put away some GTN
(tablet, yes tablets!) and adrenaline, just in case I need them, also kept the
automated defibrillator handy.
I explain my concerns to the lady and her husband. The worse
case scenario is that she is having MI, if so she would need urgent hospital
treatment. I told them that, the safest place for her to be is in a hospital
with coronary care.
Earlier on, I had discussed with the chief steward about an
urgent landing at a suitable airport for medical treatment. The chief steward
was initially reluctant. He was questioning me if the situation was really that
serious, and if his passenger really needed hospital treatment. He also
question that if I was sure that the diagnosis was MI. I had to explain to him
that, we had to take it as the worse case scenario, as we did not have the
facility to make a firm diagnosis of MI. Further more, if we cannot wait any
further as any delay could mean more myocardial damage.
I told the chief steward that, if I have seen this patient
in the middle of a city, I would want her back to the A+E department ASAP. I
don’t think being 30 000 feet above sea level made any difference. My medical
advice is that the lady needs urgent hospital treatment. And it is between the
captain and the passenger if they would like to land.
Our dilemma was solved, the lady said she was feeling better
and was adamant to stay on board and fly to Malaysia.
At this stage, I was joined by a newly qualified GP on
Honeymoon and a medical student. It was such a relief being able to discuss my
decision with the other two.
I told the lady that the best I could do for her is to try
to get her some Aspirin. With the help of the stewardess, we managed to get a
tablet of aspirin from another passenger. We also managed to “borrow” some
antacid.
After few hours, I went back to see her, she was still
complaining of mild chest discomfort, but was feeling slightly better. Again, I
advised her to seek medical help as soon as we touch down.
The old couples were very thankful for the medical help. The
chief steward later gave me a bottle of Dom Perignon as a token of appreciation.
This is my first experience managing chest pain 30 000 feet
above sea level, would like to hear your opinions, suggestions and experiences.
