A Sting In The Tale

I’m practising my CPR

A funny thing happened to me on the way to Minneapolis…

This tale has not one, but two stings in the tale.

A number of year ago I decided to take a trip to Minneapolis. It’s main (only?) claim to fame is it’s home to the Mall of America, America’s largest shopping mall, come’on, who wouldn’t want to go there?

So out of Gatwick, past Glasgow, past Reykjavik, onwards towards New Foundland, all plain sailing (or is that plane flying?). I had an American guy sitting beside me and I took great delight in showing him Father Ted comedy series on my computer.

Quiet flight, everyone settling down for a snooze….or so I thought!

Suddenly there was a commotion a few rows in front of me, an American lady stood up and started shouting at her husband “Wake up! Wake up!” this looked bad so I thought I’d better go and have a wee nosey, you know, just make sure everything was OK.

So up I got, wandered down a few rows, looked at her husband and got the shock of my life!

He was slumped in his chair, obviously not breathing, unconscious and most startling of all, his lips and the tip of his nose were very blue due to lack of oxygen! The medical term is central cyanosis, every medics nightmare!

I’ve been working in computers for the last twenty years BUT by a stroke of luck, prior to that I worked for ten years as a nurse in both General Intensive Care and Cardiac Intensive Care. What luck!

So my NHS training immediately kicked in. THANK YOU NHS!

First action must ALWAYS be call for help, so I immediately screamed “I need a Medic and I need a Medic NOW!

And then I asked one of the flight attendants to put a call out for help over the tannoy.

Next, check breathing, feel for a pulse, any response to vigorous shaking. Zero. Zero and Zero.

Crap!

I needed to start CPR (cardiopulmonary resuscitation) immediately.

Unfortunately this gentleman was by the windows seat and wasn’t light. So with strength I didn’t know I possessed, I managed to pull him from the seat and got him onto the floor of the plane in one swift move. It was a tight fit!

Next step. Start CPR, 15 compressions to each breath.

Pro tip 1. Do the compressions in tune to the BeeGees ‘Staying Alive’.

Yes.

Seriously.

Google it!

While I was doing this Ah–ONE I asked Ah-TWO the Flight Attendants Ah-THREE what Emergency Packs Ah-FOUR they had?

Fortunately (and THANK GOODNESS!) all American Airline flights have defibrillators! So off she went running for it while I carried on with CPR …Ah-FIVE…Ah-SIX

And she hurried brought the lifepack back but before handing it over I got “I can’t give you this until I see your license to practice”!

So, step one, show another willing passenger how to continue with the compressions.

Step two. Politely snatch the Defib off the young lady, we can argue about licenses later.

Step three. Connect up the Defib and pray!

Fortunately it was one of these new automatic Defibs so I connected it up, switched it on and it said;

“Assessing Patient..”

“Accessing Patient..”

“Ventricular Fibrillation”

Thank fuck! VF (Ventricular Fibrillation) is a shockable rhythm, it responds very well to cardioversion. Think of it like every single muscle fibre of the heart is firing off simultaneously, every muscle fibre of the heart is having an epileptic fit, a quivering limbo dance, and passing a charge across the myocardium resets the electrical activity and fingers crossed, they reset to sinus rhythm.

“Prepare to Cardiovert Patient–Stand Clear”

“Press Green Button”

I double checked everyone was clear and even more importantly ensured he wasn’t touching any metal parts of the plane.

Pro tip 2. Airlines are worried about mobile phones interfering with navigation equipment and ask everyone to switch them off or put the device into Airplane Mode before take-off and landing. They should be even more worried about having a Defib being used incorrectly at 38,000ft. Passing 300 joules of electrical energy through the plane fuselage means everyone’s going to have a bad day that day! It’s somewhat imperative to make sure your patient isn’t touching any metal..

So, the Defib did that whining noise we all know from the movies as it charged up.

Deep breath.

I pressed the Green Button

He did a large sudden jerk..

PLEASE PLEASE PLEASE PLEASE PLEASE PLEASE…

and the Defib called out

“Assessing Patient..”

“Requires Further Cardioversion”

FUCK, still in VF! I tuned the juice up.

“Stand Clear and Press Green Button”.

I made sure we were all clear and pressed the button again, he did another sudden jerk PLEASE PLEASE PLEASE PLEASE PLEASE PLEASE…

and then the Defib said

” Rhythm attained, please attend patient.”

Thank FUCK! Hurrah! Hurrah! I could breathe again! So could absolutely everyone else on the plane! Phew!

I read the ECG from the machine and he did indeed seem to be in a sinus rhythm, though very unstable but a rhythm with an output is enough!

The flight attendant found an oxygen cylinder, an ambu bag and a face mask with a good seal in the emergency pack so I kept his airway clear and tried to get some O2 into him. I found a stethoscope in one of the medical kits and tried listening for air entry on both sides of his lungs.

Pro tip 3. Don’t bother listening for air entry, all you’ll hear is the sound of four General Electric GE90 jet engines drowning out any airway sounds.

I glanced down the aisle. Absolutely everyone was hanging further and further out of their seats, so much so that the passengers at the end of the aisle were in danger of falling out. Kim Kardashian could’ve been standing buck naked at the end of the plane and no one would have noticed, all eyes were on us!

At this point the pilot came wandering up and asked what the score was, I told him in no uncertain terms that this man needed proper medical attention ASAP! We were about an hour out of Iceland, so he simply turned the plane around 180 degrees and headed back to land at Reykjavik…to a chorus of groans by everyone else.. Aren’t people funny, you’re a hero one minute, then your flight turns around and suddenly you’re the worse of the worse… if it had been your dad….

So we carried on like this for the hour, taking turns to ventilate, watching the rhythm, getting things ready in case he should have another arrest and at the same time trying to talk with his wife to reassure her and get some medical history.

Eventually we got near Reykjavik and the Flight Attendant said we need to take a seat whilst the plane landed for safety’s sake, I told her it was impossible to ventilate him effectively from the seat, so I sat on the floor with his head between my legs facing the direction of the aircraft while we slowed from 700mph to a very bumpy landing at Reykjavik airport.

At Reykjavik the ambulance had arrived but due to the thin aisles of the plane and him being a bit heavy we couldn’t use a ‘back-board’ to stretcher him off the plane. So they simply hauled him off in very undignified fashion with me ventilating him from the side.

Pro tip 5. Reykjavik, Iceland, February, about 5am in the morning, a bit parky. Don’t just go out in a tee-shirt!

I helped get him into the ambulance, passed on a report to the ambulance crew and very quickly got back into the lovely warmth of the 777 before I got frostbite!

We spent about the next hour tidying up the plane, getting fresh medicines on board (in case lightening did indeed strike twice!) and eventually started making our way to the States. The flight attendants were so grateful for my assistance that they put me in business class for the remainder of the trip, they kept saying just how thankful they were to have us on board.  No No, thank you American Airlines for having Defibs on every plane!

Pro tip 6. Now, dear readers, I’d like at this point to offer some very important advice.

IF at any stage in the future, you plan on having a cardiac arrest, it’s somewhat important, actually, imperative,  that you ask around your immediate vicinity the following question: “Is there anyone here with medical experience, ideally ten years’ experience working as a nurse on Intensive Care?”

If no-one replies in the affirmative then it’s probably not an ideal time to have your heart attack, you might want to postpone it until you’re somewhat closer to a hospital. Probably the very worse time and place to have a cardiac arrest is when you’re travelling at 700mph at 38,000ft halfway across the Atlantic.. If you look out the window you won’t see many ambulances out there..

And now the two stings in the tale.

1. I wasn’t actually meant to be on that flight. Gatwick Security was so bad that day that I was held up and missed my flight. So I was put on a later hop skip and jump flight. If Gatwick Security had been efficient that day then I would have been on an earlier flight and who knows what would have happened. I asked the Flight attendants what actually happens when someone dies on a flight and they said we try to carry them (covered up!) to the galley, lay him down there and try to leave them there until the flight lands.

2. On the way back to Reykjavik I asked his wife about previous medical history. They’d just spent two weeks touring England but were returning home to Dallas. She told me his father had died..yes, you guessed it, from a heart attack. Her husband had chest pains three days ago in London! I was flabbergasted…What! Surely the doctors in A&E would have absolutely refused to let him fly…reduced oxygen and all that??

“Oh no! we don’t trust your British hospitals so he didn’t go, he treated himself..” and she said he was an anaesthetist, she was a nurse and they carried an emergency pack of meds everywhere they went!

So, let me get this straight, you’re both medics, know all about the classical symptoms of cardiac failure, but rather than call an ambulance immediately or go to the nearest A&E you treated yourself because he didn’t trust our NHS hospitals.

FACEPALM!..what did you think we would treat him with? Leeches?

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