In-flight surgery with a coat-hanger and silverware(en.wikipedia.org)
en.wikipedia.org
In-flight surgery with a coat-hanger and silverware
https://en.wikipedia.org/wiki/Angus_Wallace#In-flight_surgery_with_a_coat-hanger_and_silverware
216 comments
I've had an spontaneous pneumothorax when I was a teenager. Had to undergo emergency surgery with only local anesthesia. The surgeon while cutting my chest asked: "You're sure it is this side, right?", which I confirmed. He then said: "Ok, if you're wrong I'm not going to jail alone."
This happened to me in college. Driving home from the movies, chest started to hurt on inhale .. I decided to "sleep it off", which obviously didn't work. Went to the ER in the morning. Got the chest tube and spent about a week seeing if it would heal naturally, then they removed the offending part of my lung, and did a mechanical pleurodesis (a procedure that sticks your lung to the chest wall so it can't collapse). All-in, was over two weeks in the hospital, and a good bit of recovery after.
I fit the 5'9", young, male, otherwise healthy group described here.
I fit the 5'9", young, male, otherwise healthy group described here.
For anyone reading these comments with growing anxiety who gets occasional, short duration stabbing pains when breathing in (lasting only a couple minutes at most), allow me to put your mind at ease by directing you to the Wikipedia page for precordial catch syndrome:
https://en.wikipedia.org/wiki/Precordial_catch_syndrome
Very similar symptoms, totally harmless, to the point where the recommended treatment is "reassurance". As long as the pain lasts for less than 3ish minutes, you have no reason to panic.
(I used to get very anxious every time I had these symptoms, after a friend of mine in high school described the same experience as the others in this thread, trying to sleep off the pain and ending up hospitalized for a collapsed lung. Learning about PCS really put my mind at ease)
https://en.wikipedia.org/wiki/Precordial_catch_syndrome
Very similar symptoms, totally harmless, to the point where the recommended treatment is "reassurance". As long as the pain lasts for less than 3ish minutes, you have no reason to panic.
(I used to get very anxious every time I had these symptoms, after a friend of mine in high school described the same experience as the others in this thread, trying to sleep off the pain and ending up hospitalized for a collapsed lung. Learning about PCS really put my mind at ease)
I get that every few months, though I'd describe it a bit differently:
First of all, it is usually brought on by sitting hunched over and breathing shallowly for a while (like, an hour). And the pain isn't exactly stabbing, unless you're counting being poked hard with a Popsicle stick.
It releases if I breath deeply enough, with an odd crunching sensation, sort of like popping really small bubble wrap, or cracking knuckles on a tiny hand.
First of all, it is usually brought on by sitting hunched over and breathing shallowly for a while (like, an hour). And the pain isn't exactly stabbing, unless you're counting being poked hard with a Popsicle stick.
It releases if I breath deeply enough, with an odd crunching sensation, sort of like popping really small bubble wrap, or cracking knuckles on a tiny hand.
Wow, thanks for posting this. I've had exactly these symptoms for a long time and despite multiple doctors telling me I'm fine, it's still a pretty stressful experience when it occurs!
I've gotten similar for a long time while growing up. Still get this now and then on my left side. Always my left side.
I just stretch, breath deep despite the pain and sleep it off. It... usually goes away within a day or two. The reason why I've always taken this approach is because it was always just growing pains or my ribs pinching me somehow. (Apparently that's a thing.)
That all said and done, the last time it happened I was genuinely curious and concerned, cause the last time before that I had it happen was years and years ago. And I'm not exactly growing anymore, etc. Not precisely.
But yeah. 5'6, still young-ish, and otherwise healthy I think.
I just stretch, breath deep despite the pain and sleep it off. It... usually goes away within a day or two. The reason why I've always taken this approach is because it was always just growing pains or my ribs pinching me somehow. (Apparently that's a thing.)
That all said and done, the last time it happened I was genuinely curious and concerned, cause the last time before that I had it happen was years and years ago. And I'm not exactly growing anymore, etc. Not precisely.
But yeah. 5'6, still young-ish, and otherwise healthy I think.
Beware that even a spontaneous primary pneumothrax can turn into a tension pneumothrax, a condition when a natural one-way valve forms and continuously increases pressure inside the chest eventually compressing heart and arteries.
Even a spontaneous primary pneumothrax must be handled seriously. It can become life threatening.
Even a spontaneous primary pneumothrax must be handled seriously. It can become life threatening.
Thanks for the heads up. It's been a while since the last episode, so I kind of doubt this is a thing for me at the moment. But I will keep that in mind the next time I have un-ending pinching and cramping pains on the left side of my chest. Don't worry, far left side. Not near the heart.
I had those kind of pains for years and they were always minor and went away after a few days. Always wondered what they were, but figured they were harmless. Eventually I got a worse one, went to the hospital, got a chest tube. It went away but I got another bad one, so they did surgery. A couple months later the same process happened to the other side.
I'm very glad they did a pleurectomy both times instead of pleurodesis; I've heard people describe pleurodesis and it's pretty terrifying, both the recovery and the permanent after-effects. Noticeably reduced breathing capacity isn't uncommon.
People think it's related to body type, but the surgeon said the more modern understanding is that it's due to "blebs" (actual medical term) on your lung that burst - which the pleurectomy removes. Pleurodesis is usually unnecessary in young people. I was more prone to blebs due to a genetic syndrome.
I'm very glad they did a pleurectomy both times instead of pleurodesis; I've heard people describe pleurodesis and it's pretty terrifying, both the recovery and the permanent after-effects. Noticeably reduced breathing capacity isn't uncommon.
People think it's related to body type, but the surgeon said the more modern understanding is that it's due to "blebs" (actual medical term) on your lung that burst - which the pleurectomy removes. Pleurodesis is usually unnecessary in young people. I was more prone to blebs due to a genetic syndrome.
> I'm very glad they did a pleurectomy both times instead of pleurodesis; I've heard people describe pleurodesis and it's pretty terrifying, both the recovery and the permanent after-effects. Noticeably reduced breathing capacity isn't uncommon.
I've had a pleurodesis on my left side. I never noticed any reduced breathing capacity. The procedure left a few stab-like incisions scars but I actually like them. I'd feel safer if the same was did on the right side too; I like the idea that it will never happen again on the left side but hate the feeling that it can happen again at any time on the right side.
I don't know if the procedure I was submitted is the most common. The surgeon described that they burned (cauterized, I think) the pleuras with an electric scalpel. As it healed, the pleuras stuck on one another. It was painful for just a few days but analgesics were enough to make it bearable.
There was one strange effect: it numbed the tactile feeling of parts of my breast, chest and arm. Immediately after the surgery the numbing effect was so intense that I could pierce the skin with my nails until it bled and felt not pain. I actually did it to demonstrate how numb it was. The medic said it would improve over time. It took years to get the feeling back. It's been twenty years and the feeling still is a bit numb.
I've had a pleurodesis on my left side. I never noticed any reduced breathing capacity. The procedure left a few stab-like incisions scars but I actually like them. I'd feel safer if the same was did on the right side too; I like the idea that it will never happen again on the left side but hate the feeling that it can happen again at any time on the right side.
I don't know if the procedure I was submitted is the most common. The surgeon described that they burned (cauterized, I think) the pleuras with an electric scalpel. As it healed, the pleuras stuck on one another. It was painful for just a few days but analgesics were enough to make it bearable.
There was one strange effect: it numbed the tactile feeling of parts of my breast, chest and arm. Immediately after the surgery the numbing effect was so intense that I could pierce the skin with my nails until it bled and felt not pain. I actually did it to demonstrate how numb it was. The medic said it would improve over time. It took years to get the feeling back. It's been twenty years and the feeling still is a bit numb.
That numbness is nerve damage. Sometimes you get numb, sometimes you get permanent cronic pain, and sometimes both depending on the day. More common than people might think with any sort of surgery. I had some damage that lasted about 6 years where it would be numb and then randomly about once a month I'd get a stabbing pain for like 3 seconds.
I got a head wound during a car accident I was involved with as a small child. Left about a 4” scar on my forehead. 30 years later, still no feeling in that part of my head.
Goodness, is this more common than it seems? Happened to me in my mid twenties, same build. I remember talking to the doc (thank goodness it went away with oxygen for a few days) who said "Yup, this stuff just happens to otherwise healthy males your age. No one's really sure why."
Was a little unsettling.
Was a little unsettling.
I wonder if environmental pollutants have anything to do with it.
Hope you’re doing better now. That is a lot to go through at a young age to say the least.
I am! Thank you. It's been almost 15 yrs .. I have a few scars from the chest tubes as a reminder. My lung capacity is normal. Every so often I get some numbness on that side when it's storming outside. In the couple years following, I did go through some hypochondria, thinking I had any number of related and unrelated issues. I've been advised not to scuba or go climbing Mt. Everest (ha!), though I do wonder if and when the other side could strike.
Had the same experience, at about 21, although I think they didn't cut anything out, just stapled around the hole in the lung. I was skinny and in good shape.
I’d think you were my good friend in college except the height is wrong. Didn’t realize this was so common.
About three years ago I got in a mountain bike crash and broke my collar bone and three ribs, managed to ride off the mountain (for any locals it was the Mailboxes trail in Santa Cruz) drove home to the East Bay and walked into the ER.
They did the first round of X-rays and were about to let me go since there's not much they do with ribs and collar bones these days. The last minute the Doc came back in and told me that breaking my first rib is pretty difficult and they wanted a few more X-rays which is when they found my pneumothorax and shit hit the fan. I was suddenly in a neck brace and had a Doctor shoving a tube into my chest and had to spend three days in a trauma ward to make sure everything was okay.
All this being said, I knew I had a broken Collarbone right after the fall, but outside of that I literally rode my bike three miles off the hill and drove home for an hour and walked into the ER, and was about to leave feeling fine. It's somewhat "common" for these to be missed after traumatic accidents - though most ER's know to look for them.
They did the first round of X-rays and were about to let me go since there's not much they do with ribs and collar bones these days. The last minute the Doc came back in and told me that breaking my first rib is pretty difficult and they wanted a few more X-rays which is when they found my pneumothorax and shit hit the fan. I was suddenly in a neck brace and had a Doctor shoving a tube into my chest and had to spend three days in a trauma ward to make sure everything was okay.
All this being said, I knew I had a broken Collarbone right after the fall, but outside of that I literally rode my bike three miles off the hill and drove home for an hour and walked into the ER, and was about to leave feeling fine. It's somewhat "common" for these to be missed after traumatic accidents - though most ER's know to look for them.
I used to know someone that only went to the doc a few days after the traffic accident. Incomplete neck fracture, hanging by a thread. One wrong move and she would have dropped dead on the spot.
I did some hostile environment training a while back, one of the medical courses was about "sucking chest wounds", where someone gets shot (or stabbed), and the action of breathing fills the chest cavity and thus means the lung can't work.
It's been a long time since I did the course as I went a few years without having to travel to the kinds of places where it's likely I'd need to apply it, but I do remember a plastic bag and vasseline was recommended if you didn't have a magic sucking chest wound plastic cover thing with a valve on (our med kits contain things like that and tourniquets as well as the usual stuff - including packs of sterile needles etc).
It's been a long time since I did the course as I went a few years without having to travel to the kinds of places where it's likely I'd need to apply it, but I do remember a plastic bag and vasseline was recommended if you didn't have a magic sucking chest wound plastic cover thing with a valve on (our med kits contain things like that and tourniquets as well as the usual stuff - including packs of sterile needles etc).
The civilian version of this class us called TECC (in the US) i took it last october- quite good. It is an adaptation of the military TCCC “combat casualty“ class. Thus class was specifically for EMTs and Paramedics but there us a more general class called “stop the bleed” intended fir more general audience. I think everyone should take a cpr/bls class and stop the bleed if they can. Good skills!
The Bolin Chest Seal is a sterile occlusive chest wound dressing for treating open pneumothorax and preventing tension pneumothorax...
so funny you mention the vaseline impregnated gauze. I have had more than one instructor say the best thing to use as a chest seal is the wrapper itself. Vaseline sucks to try and tape down. The metallic shiny wrapper it comes in makes a nice seal though.
While the surgeon was pointing to the left side of OP, they just answered “it’s the right side” meaning that the right side was the right side … Guess what the surgeon did.
English... what a language! The right side was actually the left side. Fortunately the talk was in Portuguese.
direito has the same issue in Portuguese, does it not?
Not exactly. "É o lado direito" is unambiguous, as the meaning of "correct" can not be used on this context.
The word "direito" in Portuguese can mean many things: "not broken", "right of law", "discipline of law" and "right side". When you're talking about sides or direction it is clear what meaning it has. Mixing the meaning of the word "direito" in Portuguese is very very rare.
This is why I say “correct” instead of saying “right.”
Doesn't help if the doctor's question was "Am I cutting into the right side?"
When I've practiced as a paramedic the best practice was to ask the patient to point to the pain and not just verbally confirm
This is probably the smartest move. When I am dealing with someone who doesn't seem to understand what I am saying due to language barrier, I start dealing with physical communication instead however possible. It can look odd, and be sort of funny to witness; but it works a charm more often than not. There are just some things we all generally understand once the body becomes involved.
Two confusing ones I hear are:
“It’s my right, your left” (not common but has occurred multiple times).
The more frequent one is where someone is trying to say “medial side of left leg” and say “it’s the right side of of my left leg”.
“It’s my right, your left” (not common but has occurred multiple times).
The more frequent one is where someone is trying to say “medial side of left leg” and say “it’s the right side of of my left leg”.
If all else fails the penis points to the problem.
This is why they draw on you with texta saying "cut here you dumbf*k" and then get you to sign three times to say the texta is correct and that you've confirmed it to all and sundry.
It seems dumb but if it saves me from having someone dissect my right knee when I wanted someone to bolt a new AC ligament into my left one, I'm all for it.
It seems dumb but if it saves me from having someone dissect my right knee when I wanted someone to bolt a new AC ligament into my left one, I'm all for it.
Was it the right side... I feel like the story ended too quickly other than you survived to write this...
It sounds like the surgeon believed that if being misled, op would also be joining the surgeon in jail. Perhaps the wrong side was chosen and the surgeon moved to the other side to finish what was originally intended.
Like a few people here, I also had spontaneous pneumothorax as a teenager, a few times. Never severe, no medical intervention required (beyond diagnosis), which I'm finding a bit strange, based on what others here are writing. This was in 1975, so maybe procedures are different now?
Anyway, I want to discuss two specific things.
1) At the time, being a young college student, I pigged out on junk food, often popcorn that I would pop in a pot using oil. I came to associate my cooking popcorn in this way with pneumothorax occurrences.
2) I was tall and quite underweight. I'm wondering if other young people who had spontaneous pneumothorax tend to be shaped similarly.
Anyway, I want to discuss two specific things.
1) At the time, being a young college student, I pigged out on junk food, often popcorn that I would pop in a pot using oil. I came to associate my cooking popcorn in this way with pneumothorax occurrences.
2) I was tall and quite underweight. I'm wondering if other young people who had spontaneous pneumothorax tend to be shaped similarly.
Perhaps insufficient protein in your diet could have contributed? It can cause connective tissue problems in adolescent athletes, so it’s not implausibly linked.
It's a funny quote, but I'm really not sure what the doctor meant...
He was joking about how the patient shared responsibility for his surgical plan
But who would accompany him to jail, a cadaver?
The patient wouldn't die, but the surgeon would have punched a hole in the abdominal cavity on the wrong side. That would create a new wound, but wouldn't fix the initial life-threatening problem. So then, he'd have to punch a hole on the correct side, fixing the problem.
After that, the surgeon would have to contend with malpractice concerns while the patient healed from two holes in their chest, one unnecessary.
After that, the surgeon would have to contend with malpractice concerns while the patient healed from two holes in their chest, one unnecessary.
There's a 'Good Samaritan' law in most states, protecting those that try to help in an emergency in good faith.
Malpractice, of course, is civil law. Nobody going to jail.
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That's the joke.
How did you get it. Was it a major accident?
No, these things just happen for a variety of reasons. Smoking/vaping puts you at higher risk. There's probably other risk factors too.
The most common category is "primary spontaneous". Predominantly young (85% <40yo), healthy males (6 times more common). Smoking contributes, and I believe being tall and skinny does so as well.
Short and fat--never a smoker. Still collapsed my right one and then the left one a week later. The doctors said they'd never seen that (bilateral in such a short timespan with no apparent cause) and had no idea what could be causing it. I had to laugh. Pectoris Excavatus or other skeletal abnormalities can cause it but I don't have any of those either. Just luck of the draw I guess.
Yeah, if you're tall and thin as well. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2950234/
Spontaneously! My lung simply ruptured. I was lying in my bed when it happened the first time.
Wait, there were more times it happened to you?
See my other comment: https://news.ycombinator.com/item?id=30710381
Sometimes it feels like a time bomb. I've been living with it for so long I just don't care anymore, it actually makes no difference in my life or plans. It prevented me from becoming a military pilot though.
Sometimes it feels like a time bomb. I've been living with it for so long I just don't care anymore, it actually makes no difference in my life or plans. It prevented me from becoming a military pilot though.
If you get one you’re more likely to have other incidents, unfortunately.
I raise you the guy who removed his own appendix in the jungle after escaping from a prisoner of war camp: https://www.smh.com.au/culture/books/the-war-hero-who-remove...
Similar to what happened to a doctor in Antarctica: https://www.antarctica.gov.au/about-antarctica/people-in-ant...
I know a guy who went there (McMurdo in Antartica) the year after this happened (so similar situation - there is only one doctor that needs to do everything for everyone). Again, you're there for a long time and there is no help coming if you have a problem in the middle of winter.
Before you go, they do as much as possible to ensure you won't have medical issues once you get there. One of the things is that they strongly suggest you get your wisdom teeth taken out. The guy I know did so a few weeks before leaving.
It turns out that his dentist was less than competent and he left parts of the tooth in the gum during extraction. So he gets to McMurdo, starts having really bad pain in his mouth, goes to the doctor and is told that his mouth is infected and teeth will need to be extracted.
The doctor reassured his patient with the words "Don't worry! I once took a one-day course in dentistry!"
Before you go, they do as much as possible to ensure you won't have medical issues once you get there. One of the things is that they strongly suggest you get your wisdom teeth taken out. The guy I know did so a few weeks before leaving.
It turns out that his dentist was less than competent and he left parts of the tooth in the gum during extraction. So he gets to McMurdo, starts having really bad pain in his mouth, goes to the doctor and is told that his mouth is infected and teeth will need to be extracted.
The doctor reassured his patient with the words "Don't worry! I once took a one-day course in dentistry!"
that they strongly suggest you get your wisdom teeth taken out. The guy I know did so a few weeks before leaving.
That seems to fall under the "If it ain't broke, don't fix it" category -- if he was an adult with no prior issues from his wisdom teeth, he'd have been better off either leaving them alone, or having them removed 6+ months prior. I'm surprised they let him do it just a few weeks ahead.
That seems to fall under the "If it ain't broke, don't fix it" category -- if he was an adult with no prior issues from his wisdom teeth, he'd have been better off either leaving them alone, or having them removed 6+ months prior. I'm surprised they let him do it just a few weeks ahead.
That was my reaction as well. I've had 75% of my wisdom teeth in for a decade+ with no issues. Seems odd to make any major medical decision so arbitrarily.
NASA first addressed this during the Skylab training. They sent two of each crew to a 14-day crash course at an Air Force dental clinic, where they took volunteers and started pulling teeth from patients.
More info: https://books.google.com/books?id=sR5Cm_zeIekC&lpg=PA84&ots=...
More info: https://books.google.com/books?id=sR5Cm_zeIekC&lpg=PA84&ots=...
You know, in normal circumstances that quote would be terrifying but I think I would have some minor relief if my only option for my issue has at least some experience!
Having had an infected tooth and impacted molars, I can safely say I would gleefully smash my own jaw with a 3 lb sledge to stop the kind of pain that tooth problems cause, so even a doctor with very limited experience would be exponentially better.
All of these incidents remind me of episodes from House MD. I swear they made one on this Antartica where House did a “zoom call”.
The airplane guy had more complications than ruptured lung but apparently he had just came out of scuba diving into the plane.
The airplane guy had more complications than ruptured lung but apparently he had just came out of scuba diving into the plane.
Or this Russian guy on an expedition in the Antarctic
https://en.m.wikipedia.org/wiki/Leonid_Rogozov#Antarctic_ser...
https://en.m.wikipedia.org/wiki/Leonid_Rogozov#Antarctic_ser...
The typical way to handle a pneumothorax (without an existing hole in the chest) in pre-hospital care is with a chest decompression needle, which is often a part of a paramedic’s kit:
https://www.narescue.com/ars-for-needle-decompression-3-25-i...
https://en.wikipedia.org/wiki/Thoracentesis
Would have been much easier than using a coat hanger and silverware if they had it on board, already pre-sterilized…
https://www.narescue.com/ars-for-needle-decompression-3-25-i...
https://en.wikipedia.org/wiki/Thoracentesis
Would have been much easier than using a coat hanger and silverware if they had it on board, already pre-sterilized…
Thats the typical way to handle a tension pneumo, which is slightly different but highly emergent. It's unlikely the case described was a tension pneumo because of the time period, but it very well could have developed that way, and regardless the treatment should be as useful - however one of the benefits of a needle decompression is that, because the lung has compressed so significantly, you don't have to be too concerned about where you drop it (ie you will always hit an airspace). whereas in the intermediate stages (which is what it sounds like they were treating), entering laterally ~4/5th intercostal space is better because you're less likely to hit lung which still occupies a significant percentage of the chest cavity - ie more likely to hit the air pocket AND provide definitive treatment (which clearly some macgyver surgery is not).
So more than likely they were aiming to intervene before it needed to be a needle decompression. But also, they were probably thinking this is going to be a ripper of a story and we've got the skills to pull it off
So more than likely they were aiming to intervene before it needed to be a needle decompression. But also, they were probably thinking this is going to be a ripper of a story and we've got the skills to pull it off
How much of a factor is the (relatively) super low air pressure in an airplane at cruising altitude? Does this cause more or less severity wrt the amount of air trapped in the chest?
So i'm not an anaesthetist and therefore I claim no high ground with regard to this rusty attempt at respiratory and gas physiology -
When I read it initially I thought - that makes sense, but I just did the equations, and basically the thing you're worried about is that the pocket of air that is outside the lung is going to change volume significantly and lead to the worst case outcome, a tension pneumo.
But the volume of air outside the lung is going to be at cabin pressure, since that's where it developed. Cabin pressure is ~75kPa. Ground pressure is ~100kPa. The lung is going to exert more pressure than the gas so if you plug all that into boyle's law then you get a 75% reduction (or actually, you don't need to plug it into a calculator, because if you can't work out the percentage of 75/100 you're in trouble, so zero points to me). which would improve/stabilise. However maybe they were concerned the change in pressure could lead to a disequilibrium between lung pressure and potential space (of which there is always some due to breathing, and that sucking pressure into what should be a vacuum is what caused the pneumothorax - air leaking through a disruption in lung tissue) - and because the pressure differential is in favour of a flow into the low pressure zone, and that differential has increased, they're worrying about it shifting materially in a matter of minutes which could get bad quickly (particularly when you consider the potential for any leakage to become progressive, rather than, say, self-limiting)
I don't know enough of this sort of edge case medicine to make any sort of definitive statements but if that was the physiology, maybe they decided it was out of the question to risk it
---
I just realised I didn't really answer your question - which relates to, i guess, basically being at cruising altitude as it develops. Because it's steady state (ie inspired air/atmospheric air is going to end up similar pressure to trapped air) basically not significant in terms of progression until you get to blood oxygenation thresholds - because there's a lower partial pressure of O2 in cabin air compared to on the ground, the decreased lung volume is going to cause these issues to become apparent more rapidly.
So it shouldn’t affect progression/growth of the pneumothorax, but it will exacerbate the physiological deterioration
When I read it initially I thought - that makes sense, but I just did the equations, and basically the thing you're worried about is that the pocket of air that is outside the lung is going to change volume significantly and lead to the worst case outcome, a tension pneumo.
But the volume of air outside the lung is going to be at cabin pressure, since that's where it developed. Cabin pressure is ~75kPa. Ground pressure is ~100kPa. The lung is going to exert more pressure than the gas so if you plug all that into boyle's law then you get a 75% reduction (or actually, you don't need to plug it into a calculator, because if you can't work out the percentage of 75/100 you're in trouble, so zero points to me). which would improve/stabilise. However maybe they were concerned the change in pressure could lead to a disequilibrium between lung pressure and potential space (of which there is always some due to breathing, and that sucking pressure into what should be a vacuum is what caused the pneumothorax - air leaking through a disruption in lung tissue) - and because the pressure differential is in favour of a flow into the low pressure zone, and that differential has increased, they're worrying about it shifting materially in a matter of minutes which could get bad quickly (particularly when you consider the potential for any leakage to become progressive, rather than, say, self-limiting)
I don't know enough of this sort of edge case medicine to make any sort of definitive statements but if that was the physiology, maybe they decided it was out of the question to risk it
---
I just realised I didn't really answer your question - which relates to, i guess, basically being at cruising altitude as it develops. Because it's steady state (ie inspired air/atmospheric air is going to end up similar pressure to trapped air) basically not significant in terms of progression until you get to blood oxygenation thresholds - because there's a lower partial pressure of O2 in cabin air compared to on the ground, the decreased lung volume is going to cause these issues to become apparent more rapidly.
So it shouldn’t affect progression/growth of the pneumothorax, but it will exacerbate the physiological deterioration
>> Wallace did not deem a landing at the nearest airport in Delhi to be viable either, because the increase in air pressure during descent could also kill his patient, and thus the only option was to perform an immediate surgery
That does not talk about the complications of the air pressure environment on the surgery itself.
The anterior axillary site is increasingly common for needle decompression as well. For the reason you mentioned, as well as the fact that it is a shorter distance (a common failure node for needle decompressions is the needle failing to reach the pleura).
„emergent“ means the prevalence is increasing? Why?
From your name and punctuation I assume you’re German.
Thats actually not the use here but that meaning is common. “Emerge” is simply Frenchified Latin for ausgehen.
In this case however it appears to be medical (perhaps ER) slang for “rapidly becoming an emergency”
Thats actually not the use here but that meaning is common. “Emerge” is simply Frenchified Latin for ausgehen.
In this case however it appears to be medical (perhaps ER) slang for “rapidly becoming an emergency”
I’ve never thought of it as slang but rather a descriptive term for patient condition but you’re bang on
Agreed:
Chronic => continual/frequent (chronos?).
Emergent => sudden (emerge?).
"Emergency Care" => "Sudden Care".
Urgent => important (urge?).
It finally made a lot of sense realizing that an "emergent condition" is something that "comes out of nowhere" and is potentially rapidly changing. Versus "urgent care" as "something that should be taken care of promptly".
Chronic => continual/frequent (chronos?).
Emergent => sudden (emerge?).
"Emergency Care" => "Sudden Care".
Urgent => important (urge?).
It finally made a lot of sense realizing that an "emergent condition" is something that "comes out of nowhere" and is potentially rapidly changing. Versus "urgent care" as "something that should be taken care of promptly".
Yes I am a German native speaker.
I assumed emergent means „rapidly increasing numbers of“ and not „ Arising suddenly and unexpectedly, calling for quick judgment and prompt action.“.
I assumed emergent means „rapidly increasing numbers of“ and not „ Arising suddenly and unexpectedly, calling for quick judgment and prompt action.“.
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Lufthansa takes this seriously. They encourage doctors to sign up for an incentive program, and about 10,000 doctors who fly Lufthansa have signed up.[1] They carry an emergency kit for use by a doctor on board, one that goes much further than a first aid kit. The airline covers medical liability.
[1] https://www.lufthansa.com/us/en/doctor-on-board
[1] https://www.lufthansa.com/us/en/doctor-on-board
Interestingly, the surgeon published a post-mortem case report titled "Managing in Flight Emergencies" in the British Medical Journal [1].
The title of the publication makes it seem as if this in-flight surgery with a coat-hanger is a routine occurrence. Remarkable!
[1] https://www.bmj.com/content/311/7001/374
The title of the publication makes it seem as if this in-flight surgery with a coat-hanger is a routine occurrence. Remarkable!
[1] https://www.bmj.com/content/311/7001/374
> The patient was now comfortable, felt well and we retired to our seats to recover. Eight hours later I was again summoned by the stewardess to see the patient, who had developed more chest pain and dyspnoea.
> I found her sitting on the toilet with the underwater seal drain on a high shelf. All the water and air had syphoned out of the bottle into the chest. The crisis resolved when I placed the underwater seal drain on the floor—draining the water back from the chest to the bottle. The air bubbled out of her chest when she coughed. After a few minutes she was almost back to normal, but exhaustion precluded the completion of a third full medical report.
> I found her sitting on the toilet with the underwater seal drain on a high shelf. All the water and air had syphoned out of the bottle into the chest. The crisis resolved when I placed the underwater seal drain on the floor—draining the water back from the chest to the bottle. The air bubbled out of her chest when she coughed. After a few minutes she was almost back to normal, but exhaustion precluded the completion of a third full medical report.
Eight hours! It's hard to believe the woman's condition was critical enough to require invasive surgery with these makeshift tools mid-flight, but so stable post-op that the doctors did not recommend an emergency landing. I understand they recommended against landing pre-op because of worries about cabin pressure, but why not after the surgery? She's going to have to come down at some point.
Maybe she didn't have any kind of health insurance in any country except the one she was traveling to. So when the doctors told her she could endure the rest of the flight, she chose to do so instead of going bankrupt by the medical fees. It would be also insteresting to know if she hid her injuries before boarding for the same reason.
I wager to say that to most people in the developed world such thoughts would not occur, and almost certainly not to Brits (that are used to the NHS).
The NHS is garbage. After experiencing them once I took on a private health insurance that cost me £300ish per month.
So now my taxes paid for the garbage public healthcare system that I didn’t want, and then I had to pay for the private insurance.
Unfortunately most people aren’t that fortunate to be able to easily justify spending extra £300 a month on health insurance so they just cope with the NHS.
So now my taxes paid for the garbage public healthcare system that I didn’t want, and then I had to pay for the private insurance.
Unfortunately most people aren’t that fortunate to be able to easily justify spending extra £300 a month on health insurance so they just cope with the NHS.
Yes, mate, you might complain about the NHS and you might wait and you might curse it, but you'd not entertain the idea of going bankrupt because you needed medical care.
Wow, only £300? Private insurance in the US is so much more than that. When you get care, is a portion paid by NHS and the remainder from the private company? Or maybe the existence of NHS puts healthcare costs much less than that in the US.
> When you get care, is a portion paid by NHS and the remainder from the private company?
It’d be NHS if the non-urgent treatment would be immediately available from them (which is basically never), otherwise I’d be sent to a private hospital.
> Or maybe the existence of NHS puts healthcare costs much less than that in the US.
This probably helps, but the US healthcare costs are just fucked for no good reason. I like to look at South Korea as an example of reasonable costs in a healthcare system that’s 100% private (the government just picks up the tab afterwards).
It’d be NHS if the non-urgent treatment would be immediately available from them (which is basically never), otherwise I’d be sent to a private hospital.
> Or maybe the existence of NHS puts healthcare costs much less than that in the US.
This probably helps, but the US healthcare costs are just fucked for no good reason. I like to look at South Korea as an example of reasonable costs in a healthcare system that’s 100% private (the government just picks up the tab afterwards).
> the US healthcare costs are just fucked for no good reason.
Amen to that.
> I like to look at South Korea as an example of reasonable costs in a healthcare system that’s 100% private (the government just picks up the tab afterwards).
From Britain you don't have to look that far abroad for this: Germany would suffice, AIUI, or maybe even just across the Channel to France. (But, hey, congrats on leaving the club of civilised nations.)
Amen to that.
> I like to look at South Korea as an example of reasonable costs in a healthcare system that’s 100% private (the government just picks up the tab afterwards).
From Britain you don't have to look that far abroad for this: Germany would suffice, AIUI, or maybe even just across the Channel to France. (But, hey, congrats on leaving the club of civilised nations.)
It's mostly lower because the scope of private medicine in the UK is generally a lot narrower: it's used for getting fast access to specialists and elective surgery, and a nicer room in hospital. If there's a serious complication when having your private hip replacement you're probably going by ambulance to an NHS ICU. Ditto emergency care. So a lot of the expensive parts of healthcare fall on the NHS even if you have private cover.
Something a little similar happens in the US: as a visitor you can get travel insurance including private medical care for much less than regular private insurance, because the insurance company isn't on the hook for long-term problems, just for a medevac back to your home country.
Something a little similar happens in the US: as a visitor you can get travel insurance including private medical care for much less than regular private insurance, because the insurance company isn't on the hook for long-term problems, just for a medevac back to your home country.
Have you ever had to navigate the US health care system?
Delhi was the nearest airport , India has[1] one of the cheapest healthcare in the world which is considered acceptable.
Tones of people fly to India to get major surgery done , medical tourism is a booming industry there.
For a British resident it wouldn't be even a factor on the top of the mind as they would be used to NHS covering everything and most people would expect travel insurance to cover this - it probably would have
[1] even in 1995
Tones of people fly to India to get major surgery done , medical tourism is a booming industry there.
For a British resident it wouldn't be even a factor on the top of the mind as they would be used to NHS covering everything and most people would expect travel insurance to cover this - it probably would have
[1] even in 1995
Doubtful. Do people go bankrupt by medical debt in other countries? Seems unlikely to get judgment and collect.
I think it’s simply unlikely because debt is always preferable to a life threatening emergency.
That being said, from a global perspective, “bankruptcy” is not a good measure of economic burden. There are worse debt outcomes than bankruptcy.
That being said, from a global perspective, “bankruptcy” is not a good measure of economic burden. There are worse debt outcomes than bankruptcy.
Bankruptcy is actually quite a piece of cake in several US states. In fact most of them even let you keep your home.
Bankruptcy is not some sort of a financial death sentence. In fact you’ll even be able to get access to credit almost immediately, because the default risk just after bankruptcy is extremely low due to the fact that you can’t declare bankruptcy for another 2-3 years.
Yes, your credit score is trashed for the next 6-7 years, but it’s also trashed with an insufferable amount of medical debt.
I would be much more upset about a 6 figure medical bill if I had 6 figures in liquid assets than I would be if I owned nothing besides some home equity.
If I have 6 figures of liquid assets, I’m wiped out, but if I own nothing, I declare bankruptcy and have a clean slate.
Bankruptcy is not some sort of a financial death sentence. In fact you’ll even be able to get access to credit almost immediately, because the default risk just after bankruptcy is extremely low due to the fact that you can’t declare bankruptcy for another 2-3 years.
Yes, your credit score is trashed for the next 6-7 years, but it’s also trashed with an insufferable amount of medical debt.
I would be much more upset about a 6 figure medical bill if I had 6 figures in liquid assets than I would be if I owned nothing besides some home equity.
If I have 6 figures of liquid assets, I’m wiped out, but if I own nothing, I declare bankruptcy and have a clean slate.
That’s what I was alluding to. Part of the high bankruptcy rates in the US are because we have very liberal laws about bankruptcy.
Not only do you get to keep your home, but the majority of people who file Chapter 7 keep everything.
That’s not to say we don’t have issues with medical costs… I’m just speaking generally about using bankruptcy rates as an indicator.
Not only do you get to keep your home, but the majority of people who file Chapter 7 keep everything.
That’s not to say we don’t have issues with medical costs… I’m just speaking generally about using bankruptcy rates as an indicator.
Can you share more about people keeping everything?
They’re called “no asset chapter 7” filings.
The TL;DR is that the law allows you to “exempt” certain assets, mostly, basic necessities that people need to live a basic productive life. The point of bankruptcy is to make people pay what they can reasonably afford, not to make them pay every penny possible. The types of assets that chapter 7 does take away are things that poor people often don’t have anyway.
https://www.nolo.com/legal-encyclopedia/what-is-chapter-7-no...
I think TV and movies have led people to believe that people “lose everything” when they file bankruptcy and end up on the streets. That’s just not reality, at least in the US.
The TL;DR is that the law allows you to “exempt” certain assets, mostly, basic necessities that people need to live a basic productive life. The point of bankruptcy is to make people pay what they can reasonably afford, not to make them pay every penny possible. The types of assets that chapter 7 does take away are things that poor people often don’t have anyway.
https://www.nolo.com/legal-encyclopedia/what-is-chapter-7-no...
I think TV and movies have led people to believe that people “lose everything” when they file bankruptcy and end up on the streets. That’s just not reality, at least in the US.
It’s not her decision, it’s the pilot’s decision to divert or not.
The pilot would make that decision based on a third party assessment of the situation relayed to them.
Having been the "is there a doctor on board" doctor before: you make the call based on what's in front of you and the turmoil that would result from a precipitous landing. The case I had to be involved with was a relatively uncomplicated chest pain. I couldn't rule out angina, but the patient was stable and they had aspirin and it started halfway into a 4-hour flight. The patient remained stable all the way through and I released the individual to EMS on the other end. I don't see what an early landing would have bought in my case, and I'm not sure what it would have bought here.
I don't understand your point. If it's no longer an emergency, why require an emergency landing?
When you just did surgery with a knife and fork seems like an urgent enough situation to land?
Maybe not if the surgery was successful. As long as the condition is stable, it might not matter where they land. Might as well land close to wherever she needs to be, instead of in a completely different country.
How is surgery “successful” when they used a coat hanger? Can you imagine the infection risk?
And sure, fly another 1-2 hr to get to the final destination, but they flew 8+ hours.
It kinda makes no sense.
And sure, fly another 1-2 hr to get to the final destination, but they flew 8+ hours.
It kinda makes no sense.
I would define a surgery's success by the success of the outcome, not by the tools that go into it. How would you define a "successful" surgery?
An in-flight surgery that stabilizes the patient indefinitely is more successful IMO than one with all the best tooling that gets the patient killed.
An in-flight surgery that stabilizes the patient indefinitely is more successful IMO than one with all the best tooling that gets the patient killed.
Not indefinitely. The point of all emergency medical treatment is to stabilize the patient before they get to a proper hospital.
> Can you imagine the infection risk?
Infection is not an automatic outcome. My grandma was an obstetric nurse, she witnessed surgeons in 1950s Southern Italy performing operations with rusty knives; and most patients would still be ok.
Sometimes we forget that the human race survived for thousands of years without the niceties of modern medicine. It's good to minimise risk, but in the end risk does not mean certainty of bad outcomes.
Infection is not an automatic outcome. My grandma was an obstetric nurse, she witnessed surgeons in 1950s Southern Italy performing operations with rusty knives; and most patients would still be ok.
Sometimes we forget that the human race survived for thousands of years without the niceties of modern medicine. It's good to minimise risk, but in the end risk does not mean certainty of bad outcomes.
They mention in passing that cognac was used to disinfect things. Not foolproof, but not exactly a sepsis inducing nightmare either.
Cognac is usually what? 30-40% alcohol?
It needs to be 70%.
https://www.cdc.gov/infectioncontrol/guidelines/disinfection...
It needs to be 70%.
https://www.cdc.gov/infectioncontrol/guidelines/disinfection...
Those guidelines recommend 60-95% ABV (and note that effectiveness drops off sharply below 50%) but also report that at least some pathogens are killed in seconds with exposure to 40% ethanol.
If all you have to disinfect your ad hoc instruments is brandy, then use it: way better than nothing.
If all you have to disinfect your ad hoc instruments is brandy, then use it: way better than nothing.
The one upside from COVID; no flight will be short of hand gel to sanitise with! Actually, is hand gel even good for that?
It's literally designed to kill bacteria. Funnily enough it does next to nothing against respiratory pathogens like covid which spread through the air not through surfaces.
One of the first things reported about the virus was that it was held together by a membrane of fatty molecules that would easily dissolve with soap. Soap literally kills the virus. So of course everybody decides to wash their hands with alcohol-based sanitiser instead.
I've never quite understood that. But there has been a lot I don't understand these past few years.
I've never quite understood that. But there has been a lot I don't understand these past few years.
Liability is a bitch, and ruins society.
If there are two doctors there saying that the situation is not urgent, then who am I to disagree with them?
The patient was stabilized but the risk of complications still exist. In such an event, it's always better to be in fully equipped and staffed hospital. The only reason not to land the plane is if it is literally impossible to do so.
Why further inconvenience everyone else for this moron, if they (clearly correctly) judged her no longer to be in danger?
I really hope that doctors don't provide medical advice based on idiocy(or lack of) of ones actions. If she had to undergo emergency surgery in-flight with a coat hanger, I'm really surprised an emergency landing wasn't recommended by the doctor. The origin of her injury should have had zero bearing on it.
If only we would leave more of these decisions to arm-chair bien-pensants, second guessing two seemingly highly competent medical professionals. I am sure the woman in question would also really have appreciated being settled with the likely ruinous debts resulting from a medically needless emergency landing.
I'm just saying I'm surprised such a decision was made, that's all.
Expecting decision making to be perfect after an accident like that is ridiculous. Bike perfectly valid and commonly used word for motorcycle in many parts of the world.
The attempt to conceal comment seems to be doctor covering his errors after an inadequate physical exam before take off.
Someone trying to conceal wouldn't complain of chest problems before take off. Most airlines would remove you from the plane before even doing an exam, and won't depend on eye doctors potentially flying to do it.
The attempt to conceal comment seems to be doctor covering his errors after an inadequate physical exam before take off.
Someone trying to conceal wouldn't complain of chest problems before take off. Most airlines would remove you from the plane before even doing an exam, and won't depend on eye doctors potentially flying to do it.
destination was Delhi - mmaybe no good medical option en route?
> underwater seal drain
He's saying that the water bottle was draining fluid from her chest, but she/someone put the bottle on a high shelf, so it drained back into her chest.
This is why you don't immediately leave post-operative patients to take care of themselves.
He's saying that the water bottle was draining fluid from her chest, but she/someone put the bottle on a high shelf, so it drained back into her chest.
This is why you don't immediately leave post-operative patients to take care of themselves.
Full content can be read via researchgate:
https://www.researchgate.net/profile/W-Angus-Wallace/publica...
> Interestingly, the surgeon published a post-mortem case report titled "Managing in Flight Emergencies"
Literally NOT a post mortem
Literally NOT a post mortem
Imagine if publication titles started being clickbait:
"Hero doctors save woman / Surgery ON A PLANE [ambulance called] [near-death]"
Some AI papers like the Yolo ones are ever so slightly like that already... maybe it's a matter of time.
"Hero doctors save woman / Surgery ON A PLANE [ambulance called] [near-death]"
Some AI papers like the Yolo ones are ever so slightly like that already... maybe it's a matter of time.
There's hacking and there is _hacking_.
My sister is training to be a doctor and she has come to dislike the heavily regulated environment we have here in which doctors are not allowed to do anything of this sort. Now, they also don't usually need to, which is a good think, but after she returned from a year in South America, she misses the on-your-feet thinking, creativity and flexibility she could and had to employ to give her patients the care they needed.
I can imagine pulling this off is a great source of satisfaction and validation.
My sister is training to be a doctor and she has come to dislike the heavily regulated environment we have here in which doctors are not allowed to do anything of this sort. Now, they also don't usually need to, which is a good think, but after she returned from a year in South America, she misses the on-your-feet thinking, creativity and flexibility she could and had to employ to give her patients the care they needed.
I can imagine pulling this off is a great source of satisfaction and validation.
Yeah, but as a South American, one thing is being able to be creative, another is _needing_ to be creative, which means doctors are not being given the resources they need (which is common here).
Of course, it's preferable to not require such creativity from doctors. But some people do well in adverse circumstances, and it takes an adverse circumstance to find out, I guess. For patients sake, I'm glad some people can focus on the outcome and not on executing protocols they learned in school.
Letting doctors have fun under pressure, or ensuring good outcomes for patients? Mmmh, I wonder what we should choose as a society... /s
Yeah, but the problem is that some doctors are not capable of doing things of this sort safely, and thus doctor regulations happen. There are definitely unnecessary regulations out there, but I imagine that most of them are simply yet another symptom of "any large enough system eventually gets ruined by abuse".
Improvised answers aren't safe. It's just sometimes they're the best of a bad set of options.
I'm naturally cool as hell when something goes wrong. Dunno why, just am (I'm definitely not especially cold-blooded in general). Weird thing happens in traffic? I act, get out the other side, and only in retrospect go "oh, wait... that was really bad" (now, oddly, if something happens ahead in traffic but doesn't affect me, after a beat I often get a pretty strong adrenaline kick that's fairly unpleasant, but for whatever reason it either doesn't happen or I never feel it at all if I actually need to react)
Work emergency? Awesome, I'm fine—great, even. Serious family problem that could be of the life-or-death sort? I will get. Shit. Done. As long as shit needs to be done, and will keep it together the whole time without a moment's lapse or even really having to try not to fall apart.
I sometimes think I'd probably have been an awesome mammoth hunter.
Alas, normal life these days rarely offers opportunities to operate at actual-peak perfect-flow state like that, and I like life enough that I've not tried to fill that void with extreme sports or anything of that sort.
I think the "I actually kind of prefer serious emergencies to normal, safe life, maybe?" thing isn't super rare. Dunno if it's normal, exactly, but I think it's common enough.
Work emergency? Awesome, I'm fine—great, even. Serious family problem that could be of the life-or-death sort? I will get. Shit. Done. As long as shit needs to be done, and will keep it together the whole time without a moment's lapse or even really having to try not to fall apart.
I sometimes think I'd probably have been an awesome mammoth hunter.
Alas, normal life these days rarely offers opportunities to operate at actual-peak perfect-flow state like that, and I like life enough that I've not tried to fill that void with extreme sports or anything of that sort.
I think the "I actually kind of prefer serious emergencies to normal, safe life, maybe?" thing isn't super rare. Dunno if it's normal, exactly, but I think it's common enough.
Famous case in Brazil: in 1998 a surgeon used cyanoacrylate glue on the heart of a patient: https://www1.folha.uol.com.br/fol/geral/gx055168.htm
Cyanoacrylate also bonds with proteins. It's a commonly used topical hemostatic and adhesive. It's usually for relatively dry and clean skin incisions but I certainly understand their attempt to use it in open surgery if things got desperate enough.
Using cyanoacrylate glue is is very common in medicine for skin closure. Doesn’t seem ridiculous to use in other settings.
The point is that most surgeons today would not pull that off, as if it goes wrong their career might end abruptly.
The patient, on the other hand, dies after “attempting all the standard procedures” and nobody is at fault.
The patient, on the other hand, dies after “attempting all the standard procedures” and nobody is at fault.
I think it was not known at that time. The surgeon asked the nurse to go out of the hospital to buy the glue.
In the US a medical formulation was not approved until 1998, but as the sibling notes it was used in the Vietnam War by US medics. Medical studies in the 1980s showed it to be superior to stitches [1]
Cyanoacrylate is just (a very - the most? - common form of) superglue, but the medical formulations were tweaked to be less harmful to skin among other benefits.
There is also VetBond, which is similarly n-Butyl cyanoacrylate as are some medical-grade superglues, but it is only approved for animal use and thus available without a prescription (despite being chemically identical to somemedically approved glues).
[1] https://en.wikipedia.org/wiki/Cyanoacrylate#Medical_and_vete...
Cyanoacrylate is just (a very - the most? - common form of) superglue, but the medical formulations were tweaked to be less harmful to skin among other benefits.
There is also VetBond, which is similarly n-Butyl cyanoacrylate as are some medical-grade superglues, but it is only approved for animal use and thus available without a prescription (despite being chemically identical to somemedically approved glues).
[1] https://en.wikipedia.org/wiki/Cyanoacrylate#Medical_and_vete...
It was well known for quite some time before that.
US Combat Medics used it in the field in Vietnam in the '70s.
US Combat Medics used it in the field in Vietnam in the '70s.
First I heard of it was when my kid was rushed to hospital from kindergarten for a cut above hos eyebrow (where his best friend had thrown a toy car at him, probably in a tiff about who'd get to play with it) in ~2006-7. It was a funny colour, a bright light purple; I presume for better visibility (in contrast to most normal human skin colours) both at application and afterwards. Faded away after a few days IIRC; can't recall any return visit to check on it.
[deleted]
> She stated she had fallen from a "bike", by which Wallace assumed she meant a bicycle.
> It emerged that she had not merely fallen from a bicycle but had been flung to the ground while riding on a motorcycle that collided with a car
> Wallace suspected she had previously concealed the extent of her injuries so as to avoid being taken off the flight.
Taking medical history is very hard. Patients minimizing their symptoms or omitting details are just one of many things doctors have to deal with on a daily basis.
> It emerged that she had not merely fallen from a bicycle but had been flung to the ground while riding on a motorcycle that collided with a car
> Wallace suspected she had previously concealed the extent of her injuries so as to avoid being taken off the flight.
Taking medical history is very hard. Patients minimizing their symptoms or omitting details are just one of many things doctors have to deal with on a daily basis.
Many people call motorcycles "bikes". I wouldn't even call this omitting details.
'the doctors successfully released the trapped air from the patient's chest, and she spent the rest of the flight uneventfully eating and watching in-flight movies'
How does one do that after having a hole cut in one’s chest? Pain-wise.
The hole had lidocaine, a relatively good topic anesthetic. If don't move too much, the tube inside the chest doesn't causes too much pain. Actually, once the tube is inserted the feeling of relief and been able to breath normally is quite good. Disclaimer: I've had 3 spontaneous pneumathoraces.
> 3 spontaneous pneumathoraces…
I remember from EMT school the informal advice that spontaneous pneumo is a predisposition for certain body types and something as trivial as a burp or hiccups can cause. Tall and thin body type. But this is anecdotal- is there an underlying cause in your case?
I remember from EMT school the informal advice that spontaneous pneumo is a predisposition for certain body types and something as trivial as a burp or hiccups can cause. Tall and thin body type. But this is anecdotal- is there an underlying cause in your case?
> spontaneous pneumo is a predisposition for certain body types
Some medics said exactly this for me. This body type is called "franzino" in Brazil and is exactly how I was as a teenager. Strangely my pneumathoraces were not on the same side. On the left side it happened twice which was fixed with two clamps and a pleurodesis. On the right side it occurred only once but considering my predisposition, there's no reason to think it will never happen again.
Some medics said exactly this for me. This body type is called "franzino" in Brazil and is exactly how I was as a teenager. Strangely my pneumathoraces were not on the same side. On the left side it happened twice which was fixed with two clamps and a pleurodesis. On the right side it occurred only once but considering my predisposition, there's no reason to think it will never happen again.
Jesus christ mate, human biology is fucked.
Imagine walking around knowing your lungs could pop for essentially no good reason, at any moment.
Imagine walking around knowing your lungs could pop for essentially no good reason, at any moment.
lidocaine, a relatively good topic anesthetic.
Sure… But a hole in one’s chest isn’t exactly topical, right?
But what do I know? Can lidocaine be injected… sub… topically?
Sure… But a hole in one’s chest isn’t exactly topical, right?
But what do I know? Can lidocaine be injected… sub… topically?
Presumably the patient had quite a high pain threshold, since she was already ignoring a broken arm and ribs in addition to the pneumothorax in order to make her flight.
There isn't much you can do about broken ribs afaik?
And the broken arm depends on the type of break. I split my humorous bone length ways. Initially because of adrenaline, it was absolutely painless, after an hour the pain kicked in. If I didn't move my arm it was fine but if I moved it, wow, 2nd most painful experience in my life.
And the broken arm depends on the type of break. I split my humorous bone length ways. Initially because of adrenaline, it was absolutely painless, after an hour the pain kicked in. If I didn't move my arm it was fine but if I moved it, wow, 2nd most painful experience in my life.
> If I didn't move my arm it was fine but if I moved it, wow, 2nd most painful experience in my life.
Yeah it's interesting how this works.
I once broke my collar bone (I tried jumping up a curb on my bike, the handle bars fell off and I went collar bone first into the edge of the curb). I ended up carrying my bike home in pieces for half a mile and remember it not being too bad. As long as I kept my arm at my side it didn't feel any different than normal but when I lifted up my arm it was one of the sharpest pains I've ever experienced. I only ended up having a hairline fracture too.
Yeah it's interesting how this works.
I once broke my collar bone (I tried jumping up a curb on my bike, the handle bars fell off and I went collar bone first into the edge of the curb). I ended up carrying my bike home in pieces for half a mile and remember it not being too bad. As long as I kept my arm at my side it didn't feel any different than normal but when I lifted up my arm it was one of the sharpest pains I've ever experienced. I only ended up having a hairline fracture too.
> As long as I kept my arm at my side it didn't feel any different
As someone who watches bike racing, it is often immediately apparent when someone has broken their collarbone by the way they keep their arm.
As someone who watches bike racing, it is often immediately apparent when someone has broken their collarbone by the way they keep their arm.
> I split my humorous bone length ways
So you're hilarious, now that you have an extra funny bone?
So you're hilarious, now that you have an extra funny bone?
A guess, but a good belt of whisky, some asprin, and happiness at not being dead?
The BMJ report states that the onboard medical kit had local anaesthetic available (though it also states that "in the heat of the moment, neither I nor Dr Wong were able to calculate the percentage of lignocaine in it" and isn't entirely clear about whether they used it anyway or went in without).
They did use a good belt of ("5 star") brandy, but for equipment sterilisation rather than pain control.
They did use a good belt of ("5 star") brandy, but for equipment sterilisation rather than pain control.
Adrenaline is a hell of a drug.
It’s not comfortable (pleural rubbing of catheter) but analgesia requirements for a chest tube post insertion are pretty minimal
I’m not sure which one was more badass, the surgeon or the patient.
It's so good it warrants standing applause.
The funny thing is, as an orthopedic surgeon in England, Wallace probably hadn't put in a chest tube in years, while the other "junior" doctor training in internal medicine, Tom Wong, probably did one every week. I have no inside knowledge, but I suspect Dr Wong probably did most of the procedure while the senior doctor Wallace took most of the credit later.
As the senior doctor, Wallace was certainly responsible for the care of the patient, which makes his inadequate examination of the patient while still on the ground, and his failure to recommend the patient be sent to the ER for a full examination a little concerning. If true, advising the plane NOT to divert and land because it might make the pneumothorax worse is also strange - as I understand it, you would expect the gas in a pneumothorax to get smaller as the pressure in the cabin returned to (sea level) atmospheric pressure, unless Boyles Law no longer applies? :) [Edited to clarify "atmospheric pressure" means sea level pressure in this case]
As the senior doctor, Wallace was certainly responsible for the care of the patient, which makes his inadequate examination of the patient while still on the ground, and his failure to recommend the patient be sent to the ER for a full examination a little concerning. If true, advising the plane NOT to divert and land because it might make the pneumothorax worse is also strange - as I understand it, you would expect the gas in a pneumothorax to get smaller as the pressure in the cabin returned to (sea level) atmospheric pressure, unless Boyles Law no longer applies? :) [Edited to clarify "atmospheric pressure" means sea level pressure in this case]
That makes sense. Once I took a packet of Doritos on board, and it blew up like a balloon once the plane took off and went to cruising altitude!
I live at about 5000ft and all our packages are extra poufy. It amuses me every time I go to the store.
My first flight on a plane also happened to had a passenger have a medical problem. She had passed out briefly. The pilots had that plane turned around fast and paramedics were waiting at the gate.
I'm just stunned they would still take off with a clearly injured passenger. And then not turn around after an hour into the flight!? They didn't want to land in India, but Hong Kong was only an hour away?
I'm just stunned they would still take off with a clearly injured passenger. And then not turn around after an hour into the flight!? They didn't want to land in India, but Hong Kong was only an hour away?
I don't think the ground exam was flawed--rather, she was downplaying the problem because she wanted to fly.
The surgeon noted in the case report that he didn't carry out a full primary survey on the ground, for reasons that seem a bit weak in retrospect.
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Stories like these reminds me how a lot of talent is going waste trying to improve CTR on Ads and other futile jobs.
I’m not sure those people would make great surgeons or physicians as a rule. I don’t think lack of talent or intellectual horsepower in medicine is an issue at all.
Yeah, but even if they don't take jobs as surgeons or physicians, basically literally any other job would have more net benefit to society :)
The European rules for emergency medical kit (I guess FAA rules are very similar) also automatic defibrilators are increasingly being included in these kits:
CONTENT OF EMERGENCY MEDICAL KITS
(a) Emergency medical kits should be equipped with appropriate and sufficient medications and instrumentation. However, these kits should be supplemented by the operator according to the characteristics of the operation (scope of operation, flight duration, number and demographics of passengers, number of decks, etc.).
(b) The following should be included in the emergency medical kit:
(1) Equipment
(i) sphygmomanometer — electronic recommended;
(ii) stethoscope;
(iii) syringes and needles;
(iv) intravenous cannulae (a sufficient supply of intravenous cannulae should be available, subject to the amount of intravenous fluids carried on board);
(v) oropharyngeal airways (three sizes);
(v) tourniquet;
(vi) disposable gloves;
(vii) needle disposal box;
(viii) one or more urinary catheter(s), appropriate for either sex, and anaesthetic gel;
(ix) aspirator;
(x) blood glucose testing equipment;
(xi) scalpel.;
(xii) pulse oximeter; and
(xiii) pneumothorax set.
(2) Instructions: the instructions should contain a list of contents (medications in trade
names and generic names) in at least two languages (English and one other). This should
include information on the effects and side effects of medications carried. There should also be basic instructions for use of the medications in the kit and guidance for conversion
of units for the blood glucose test. The operator should make the instructions readily available. If an electronic format is available, then all instructions should be kept on the same device. If a paper format is used, then the instructions should be kept in the same
kit with the applicable equipment and medication.
(3) Medications
(i) coronary vasodilator e.g. glyceriltrinitrate-oral;
(ii) antispasmodic;
(iii) epinephrine/adrenaline 1:1 000;
(iv) adrenocorticoid;
(v) major analgesic;
(vi) diuretic — injectable;
(vii) antihistamine — oral and injectable (including paediatric form);
(viii) sedative/anticonvulsant — oral plus injectable and/or rectal sedative;
(ix) medication for hypoglycaemia (e.g. hypertonic glucose);
(x) antiemetic — injectable;
(xi) antibiotic — injectable form — Ceftriaxone or Cefotaxime;
(xii) bronchial dilator — inhaled (disposable collapsible spacer);
(xiii) IV fluids in appropriate quantity e.g. sodium chloride 0.9 % (minimum 250 ml); and
(xiv) acetylsalicylic acid — oral — for coronary use.
CONTENT OF EMERGENCY MEDICAL KITS
(a) Emergency medical kits should be equipped with appropriate and sufficient medications and instrumentation. However, these kits should be supplemented by the operator according to the characteristics of the operation (scope of operation, flight duration, number and demographics of passengers, number of decks, etc.).
(b) The following should be included in the emergency medical kit:
(1) Equipment
(i) sphygmomanometer — electronic recommended;
(ii) stethoscope;
(iii) syringes and needles;
(iv) intravenous cannulae (a sufficient supply of intravenous cannulae should be available, subject to the amount of intravenous fluids carried on board);
(v) oropharyngeal airways (three sizes);
(v) tourniquet;
(vi) disposable gloves;
(vii) needle disposal box;
(viii) one or more urinary catheter(s), appropriate for either sex, and anaesthetic gel;
(ix) aspirator;
(x) blood glucose testing equipment;
(xi) scalpel.;
(xii) pulse oximeter; and
(xiii) pneumothorax set.
(2) Instructions: the instructions should contain a list of contents (medications in trade
names and generic names) in at least two languages (English and one other). This should
include information on the effects and side effects of medications carried. There should also be basic instructions for use of the medications in the kit and guidance for conversion
of units for the blood glucose test. The operator should make the instructions readily available. If an electronic format is available, then all instructions should be kept on the same device. If a paper format is used, then the instructions should be kept in the same
kit with the applicable equipment and medication.
(3) Medications
(i) coronary vasodilator e.g. glyceriltrinitrate-oral;
(ii) antispasmodic;
(iii) epinephrine/adrenaline 1:1 000;
(iv) adrenocorticoid;
(v) major analgesic;
(vi) diuretic — injectable;
(vii) antihistamine — oral and injectable (including paediatric form);
(viii) sedative/anticonvulsant — oral plus injectable and/or rectal sedative;
(ix) medication for hypoglycaemia (e.g. hypertonic glucose);
(x) antiemetic — injectable;
(xi) antibiotic — injectable form — Ceftriaxone or Cefotaxime;
(xii) bronchial dilator — inhaled (disposable collapsible spacer);
(xiii) IV fluids in appropriate quantity e.g. sodium chloride 0.9 % (minimum 250 ml); and
(xiv) acetylsalicylic acid — oral — for coronary use.
What emergency would necessitate a urinary catheter?
Enlarged prostate blocking the flow of urine for one example. My grandfather couldn't relieve himself without a catheter during the last year of his life.
expected an AED - wonder if inflight vibration makes it unusable
In the US all commercial airlines are required to carry AEDs and train staff to use them. So the internet tells me
NJ EMT here and the guidance we are given is to not run AED while driving as the vibrations can make the analyzer misread. There are probably different types of AEDs to account for this
I’m guessing the tradeoff in the air is worth it. Can’t stop to run an AED and if they need a shock it’s because they’re in a potentially fatal rhythym
There also isn't constant vibration while flying (except during turbulence) like there is while driving.
Does Dr. Wong have a Wikipedia page?
I'm surprised by the point about pressurization... cabins do depressurize on ascent, but... marginally. Would a difference in a few thousand feet atmospheric pressure, equalized SLOWLY, really have been that big an issue?!
IIRC planes are pressurized to 6000' equivalent, and a quick Googling show that to be 11.7psi or about a 3 psi drop vs ground level. Also, changes of much less than that can cause discomfort in your ears if not equalized. I have no idea what 3psi does to the lungs, but with all the discussion about ventilators from 2020 I'd say that's a LOT of pressure on them.
So, the gas volume would change by a ratio of 15/12, or increase about 25%.
US government is more likely to say "Well if all you needed was a coat hanger and a knife and fork, you don't even need a medical kit!" than require or provide proper medical supplies on a plane.
This is very cool. I like this place because it has threads like this you wouldn't usually find. Today, this guy would probably go to jail or let the person die because it's less legally complicated.
This line got me:
"the doctors successfully released the trapped air from the patient's chest, and she spent the rest of the flight uneventfully eating and watching in-flight movies"
"the doctors successfully released the trapped air from the patient's chest, and she spent the rest of the flight uneventfully eating and watching in-flight movies"
For me it was:
> They sterilised their equipment in cognac
Is there a % alcohol requirement for using spirits to sterilize equipment?
> They sterilised their equipment in cognac
Is there a % alcohol requirement for using spirits to sterilize equipment?
eau de vie has an ABV of 72%, according to [1]. That's high enough to kill coronavirus, according to [2]
[1] - https://blacktailnyc.com/wh at-is-the-abv-of-cognac/
[2] - https://www.marthastewart.com/7796118/isopropyl-alcohol-perc...
[1] - https://blacktailnyc.com/wh at-is-the-abv-of-cognac/
[2] - https://www.marthastewart.com/7796118/isopropyl-alcohol-perc...
It says it was cognac, which is typically around 40%. That was probably the strongest alcoholic drink on the plane.
(70% in the maximum strength passengers are allowed to take, anything stronger is considered a flammable liquid.)
(70% in the maximum strength passengers are allowed to take, anything stronger is considered a flammable liquid.)
I've seen this in a rom-com before, where they poke a hole in the person's chest and they survive by decompressing the trapped fluids out of the hole.
Weird to think about surviving something because you were stabbed in the right spot.
Cool stuff.
Weird to think about surviving something because you were stabbed in the right spot.
Cool stuff.
Just Like Heaven. It's just like heaven where he jabs the guy with a steak knife because he's haunted by the unsettled spirit of a female MD, whom he later falls in love with.
Mark Wahlberg's character in Three Kings has to do this after getting shot while wearing kevlar because his lung collapsed.
I believe there is a rather gruesome in situ depiction of the pnuemothorax
*pneumothorax
Now I am curious about improvised in-air operations that were not successful?
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Oh he was a trained surgeon. Meh. LMK when the most experienced nearby medic is a meat-packer.
Haha! My grandfather was an orthopaedic surgeon in Edinburgh, and a friend of Mr Wallace...
Yet another reminder that human bodies are incredibly fragile
I somehow read the last sentence of the second paragraph as "and she spent the rest of her life uneventfully eating and watching in-flight movies" and was very confused.