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July 7th:

I took a red-eye out of LAX for Florida. All the lights were out for passengers to sleep. About 2 hours into the flight, all the TV screens illuminated with the message, “Physician needed in the forward most area of aircraft”.
Then, the announcement for physician needed came over the intercom. To my dismay, I saw no one go up to help. I sighed an”Awe crap” under my breath & went to see if a mere RN would be sufficient for the emergency. They seemed eager for my assistance as I entered the scene and introduced myself to crew & patient.
The bad news: An elderly woman from 1st class had collapsed just outside the cockpit.
The good news: It was NOT the pilot. ๐Ÿ˜‰
The flight attendants were supporting her with cool compresses & attempting to place oxygen on her via mask. ย She was refusing 02, refusing assistance, & repeating, “I’m alright, I’m alright.
I introduced myself, and sat on the floor with her. After my initial scene observation & ABC’s (CAB),
I began my triage questions & observations.
Getting her to cooperate & offer up the necessary info I needed to rule out stroke, heart attack, diabetes, seizure disorder, dysrhythmia, hypertension, & other things was difficult at 1st.
She kept brushing everyone off saying “I’m fine”. The family of 8, all in 1st class were being overbearing. I politely asked everyone to take their seat & to not hover as the patient was extremely embarrassed & becoming agitated with everyone closing in on her.
She had given me permission to assess & help, but each question about history, medication, & current symptoms were met with a dismissive, authoritative, “I’m fine!”
Finally I told her to open her eyes & to look into mine. I said kindly, but directly, “You need to be here with me now, cooperate with me and answer my questions so I can clear you to finish this flight.”
If “I” am not satisfied that you are fine, then the pilot will need to land this plane right now, because at this moment, I am not convinced that you are alright.
At that point she let us place oxygen, take a blood pressure, and she answered all my questions appropriately, so that I could rule out any urgent need to land.
My final analysis? Nothing life threatening. Most likely a
vasovagal syncope event.
Basically, an elderly woman with gastric reflux disease, who took blood pressure med prior to flight, became nauseated, hot, & claustrophobic. She was tired, & dehydrated, but thought a shot of liqueur in 1st class would be a good idea. Then when she felt sick to her stomach, she got up too fast, & passed out even faster.
I helped her up and advised her to avoid alcohol & caffeine the rest of the trip to avoid a recurrence of reflux & nausea.
The family & crew was very pleased that I did not tell the pilot to abort the flight plan. So pleased that they all wanted to buy me cocktails for the duration of the long flight to the east coast.
I had to smile and politely decline as I just celebrated 22 years of clean & sober time. ๐Ÿ˜‰
That was day 1 of my Florida vacation.

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