Case Scenario While we were flyin...

Case Scenario

While we were flying hearthstone from a vacation, my husband abruptly woke me from a unfathomable sleep by saying, "Wake up they're calling for a doctor." common of the passengers had misspent consciousness. When I got to the back of the cabin, another physician, who had already rejoined asked me about my medical specialty. I told him I am a family physician. He then asked me to take across stating that this was "out of his field."

The patient was seizing. Somewhat terrified, I followed the ABCs of unforeseen occasion care. It took numerous attempts to commit to memory an intravenous (IV) line inserted, and there was offspring everywhere. The airline emergency kit had lorazepam, likewise while I was trying to insert the IV, I administered the medication intramuscularly to mastery the seizures. The pilot asked whether he should plan to reroute the plane for an earlier landing. I said ye because at the time the patient was still seizing. Eventually, the seizures stopped.

Meanwhile, we learned that the patient was an alcoholic and that these were withdrawal seizures. from the time the patient became stable, however, it was impossible to land at our scheduled airport. Later, forward the ground at the airport to which we had been diverted, pressing necessity personnel seemed to suggest that I was incompetent for delivering the lorazepam intramuscularly. Overall, it was an exhausting, scary experience, and my husband and I didn't master home until the next day. The airline did levy us up in a [i]cabaret[/i] in the city to which our flight had been diverted.

Was I obliged to provide assistance in this case? Am I screened legally? What do you think about the first physician who handed athwart the care? Do the airlines typically compensate physicians who help abroad in these circumstances?

Commentary

Although usually it's just the in-flight movie and aliment we get to fret about, unfortunately, in-flight emergencies are a usual occurrence. In fact, approximately 1000 cardiac arrests come about each year on airplanes, which is more than the total number of commonalty who die in plane crashes each year. (1) The clinical scenario described here is all too common

Is a physician obliged to give assistance in this situation? In a previous Curbside Consultation in American Family Physician (2) involving a shipwreck on the highway, I noted that many medical societies state that physicians have a moral and ethical responsibility to act in these cases. In a certain number of states, there is also a legal requirement to assist those in extremity care.

But what about the legal risk to a physician who get by hearts involved in such a situation? In today's medicolegal environment, business about legal protection for performing a "Good Samaritan act" is certainly understandable. generally all 50 states have near form of Good Samaritan legislation. however what legislation covers a physician who is flying? The Aviation Medical Assistance Act, which was passed on Congress in 1998, "... limits non-employee passenger liability for providing assistance during an in-flight medical affair unless the assistance is grossly negligent, or is willful misconduct." (3) To date, no physician has been su favorably for rendering assistance in this situation.

As for the actions of the other physician in this case, I can no other than speculate that he did not be warmed comfortable managing this patient. If more than united health care worker is ready in such a circumstance, the one with the most experience or expertise should manage the care of the patient. The family physician in this scenario should be vain-glorious of the fact that she was willing and able to save this patient's life.

And, indeed, this case scenario involved a potentially life-threatening condition. level though managing patients with alcohol-related illness may not be many physicians' favorite pastime, unadorned withdrawal and delirium tremens remain potentially life-threatening conditions. Up to 5 percent of patients with "the dts" die, and this rate increases if there are underlying medical puzzles At 30,000 feet in the air, there is no way to know anything about the patient's medical history or to perform diagnostic testing. The decision to land the plane, whether the patient continued to seize or not, was absolutely correct.

Benzodiazepines remain the mainstay of therapy in patients with acute seizures, whether the latter are induced by way of alcohol or not. In particular, lorazepam (Ativan) has not long ago been shown to be somewhat more effective than diazepam (Valium) in the treatment of out-of-hospital status epilepticus, (4) and it was the correct choice in this case. Ideally, it would have been best to titrate the benzodiazepine intravenously, unless as described in this push situation, this is not always possible (see accompanying table). for what cause many of us can say with any certainty that we could insert an IV line in a patient who is thrashing about? This situation demonstrates the probable reason that we have advance up with so many alternative roads to deliver these agents. Benzodiazepines can be given intravenously or intramuscularly, or from intra-nasal, buccal, or rectal application, alternative courses that can come in handy in juncture situations.