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race as I wondered if there was a doctor or nurse who could help me. A crew member handed me the unopened emergency first-aid kit. I had never seen one before. I opened it and there before me was a stethoscope, a blood pressure cuff and sphygmomanometer. A checklist enumerated a list of drugs were available. I felt for his radial pulse, I thought I felt something but could not be sure. Perhaps I was feeling the pulsations of my own blood surging in my fingertips which were now in a heightened state of alertness. I reached for the brachial artery and the carotid. I felt a definite pulse but it was fast and thready. His heart rate was 120 beats per minute and perhaps faster. I touched his abdomen. He immediately held his breath. Guarding, hard-board rigidity, rebound tenderness! Acute abdomen! All very well but what in the world was an ear nose and throat doctor to do with a hot belly? Years of hard surgical training helped me make the diagnosis even in this high pressure situation.
By now four or five of flight attendants stood by, wanting to help but not really knowing what to do. A young doctor from Florida made his way back from the first class section. He was mourning the loss of his own brother in the Philippines and had decided on this trip at the last minute.
“ I am a cardiologist and am happy to help but I have not started an IV in years,” he declared.
“ Would you mind spiking the bags of IV fluid, cut strips of tape, and help if I needed it?” I asked. Despite his own personal grief, he was eager to help.
A hot abdomen, veins collapsed, tachycardia, diaphoretic, a patient in shock on a noisy airplane; where was the phlebotomist when one was most needed? What was his blood pressure? I wrapped the cuff around his arm and listened through the stethoscope for the lub-a-dub on his brachial artery, as I slowly deflated the cuff. I could hear nothing over the sound of the engine. I tapped on the
18 LOUISVILLE MEDICINE
Dr. Gadre assists a fellow passenger on his transpacific flight from Detroit to
Nagazaki, Japan. diaphragm and re-inflated the cuff and gave it one more go. The needle seemed to oscillate but still no knocks.( I soon realized that a stethoscope is useless to measure blood pressure on a moving jet aircraft.) All one can hear is the sound of the engines. In my view, airlines ought to substitute these old dial aneroid instruments with modern electronic devices). I recollected the palpatory method they taught us in physiology class at medical school. I inflated the cuff again and let it down slowly as one more cry of pain emanated from his parched cracked lips. Systolic blood pressure was 80mm of Hg! He attempted to say something, which was incoherent to me. The only word I understood was“ Tokyo” as he now seemed to lapse in and out of consciousness. His young traveling companion began to sob quietly.
I left the cuff inflated and reached for the 20 gauge angiocath. Mr. MB, the chief flight attendant, was calm and kind, and helped as best as he could. He held the flashlight as I palpated the slowly filling vein in the man’ s wrist. A flash of dark red blood presented in the hub of the needle. I advanced the cannula smoothly into the vein. I only prayed that I did not mess up the vein stick as I may not have another chance. My cardiologist friend had expertly primed the intravenous tubing as I hooked a 500 ml bag of normal saline into the waiting angiocath. It flowed freely. I asked the attendant to open the spigot as I secured the angiocath to the cold clammy skin. Not knowing what to do, she shut it off. My legs were now cramping from the alternate kneeling and squatting positions I had to assume to get the job done. I came to my feet feeling light headed. I saw another human being in a desperate condition on the floor. He was alive but sinking fast. I had to get his blood pressure up. I squeezed the bag that someone had now secured to a coat hook, as the first 500 ml of life giving normal saline rapidly entered his veins.
By now the captain joined the crew and asked me for some details. I told him all I knew, as he took down notes.
“ How much longer, and are we over US or Canadian airspace?” I asked.
“ More than 10 hours to go, do you think he can make it for that long?” he asked, his forehead wrinkled with inquiring worry.
“ The risk is too great,” I told him.“ Its best to get him to a hospital.”
He called out the parameters that I had given him, which included only pulse, systolic blood pressure and respiratory rate. He walked toward the cockpit to inform Delta Airlines headquarters in Atlanta and to obtain advice from the Mayo Clinic. I hooked up a second bag of normal saline and squeezed it in, and with two empty bags down and nothing else to do, I hung the third bag. I wondered what