4F

It had been a long week; looking back, it had been a long few months and I was ready for a vacation. I was in (middle) seat 22E, American Airlines headed for the Tropics with my family. It was an overnight flight and I had just closed my eyes when a classic P/A line awakened me: “If there is a doctor on the plane, please immediately identify yourself to a flight attendant”.

OK, for us general dentists this can be an awkward moment. We’re “doctors” but not the highly exalted M.D. variety. So I decided to wait a bit to see if a “real doctor” swaggered up the aisles. No movement. After a long 10 seconds, I left my seat and walked to the front of the plane.  An obviously concerned flight attendant greeted me. “Oh doctor, thank you so much for coming, the man in 4F has passed out”. I had to come clean with her so my answer was “I’m a dentist,  I’ll see what I can do”. I’m very awake now and wondering what the odds are of me being the only person onboard with some form of medical training. The man/patient in 4F had apparently lost consciousness trying to get out of his seat. His first class neighbors helped him back into his seat and I found a semi-conscious obese male approximately 50 years of age.

Cue the amazing phenomenon of “crisis acuity and slow motion”. Many of us have experienced this; in a crisis, time somehow slows down and you are acutely aware of actions and details.

ABC. Airway, Breathing, Circulation. As dentists we are mandated to know this and our basic life support training so that’s where I started. 4F’s seat was already back which, aside from him having no discernable neck, helped in opening his airway. Though shallow, he was breathing. Excellent, that means he’s circulating as well. 4F’s wife now makes herself known with “oh doctor, you can save him can’t you?” Great, at least there’s no pressure…

An interesting side note at this point. All U.S. commercial airlines carry A.E.D.’s, portable oxygen and a fairly extensive emergency medical kit. The attendant hands me the kit and another helps me start some oxygen. I locate the blood pressure cuff and stethoscope. After some difficulty (I really could have used an extra-large cuff) I obtained a reading of 120/90. Not great, but quite alive at 35,000 feet. 4F’s breathing now starts to stabilize, color returns to his (and his wife’s) face, and I’m able to ask some basic questions- General health, medications, allergies, what happened before losing consciousness and most importantly: did he have the fish or chicken for dinner (sorry, old Airplane joke).

I next had the privilege of meeting our flights captain who asks, “Do we need to declare a medical emergency and divert to the nearest airport”? Interesting dilemma: carry on over water to the tropics assuming 4F is stable or land the plane ASAP for definitive medical assessment? After gathering all available information, my differential diagnosis led me to a fairly strong conclusion: orthostatic (postural) hypotension. 4F had “a few” Scotches after take-off, enjoyed wine with his dinner (fish), finished with a hot fudge sundae, snoozed a little and rather urgently arose from his seat to answer natures call. The big man in 4F apparently fainted. I was about 90% sure of my diagnosis which I explained to the captain and the flight proceeded to its scheduled destination without further incident.

As dentists, we are trained to deal with a variety of clinical situations. With time and experience, we learn how to listen to, and gather appropriate information from our patients. We are here to help and above all “do no harm”. Check the meds in your emergency kit and know how to use them. Know where you’re A.E.D. is located. Practice a “mock emergency” with your staff on a regular basis. Make sure you are current and proficient with your BLS/CPR. You never know when you may be in 4F with a problem and the only person around to help is a dentist.