Airplane Medical Emergency | WE COULDN’T LAND! | Wednesday Checkup

– I wanna give a shout out
to our BAMF of the day, the internet and YouTube’s own Dr. Mike. – Passenger went into anaphylactic
shock during a flight. – Thankfully, Dr. Mike was on board. – I think it’s story time. (stirring music)
(heart monitor beeping) I was headed to Israel to work with a nonprofit called
America’s Voices in Israel. They wanted me to meet some med tech CEOs, visit some hospitals, some nonprofits, visit with the university faculty and chat about their research. But the trip going there was quite eventful, to say the least. We’re about two hours into the flight, we’re over the Atlantic Ocean, and the flight attendants
make that announcement. Is there a medical professional on board? I don’t know why I’m
holding a mic like this. They have phones. Is there a medical professional on board? The flight attendant’s right next to me. I’m a doctor, I can help. I’m not wearing shoes. I have a hoodie on. And I look like I haven’t slept in days because my strategy was to sleep on the plane going there to
reset my circadian rhythm. The flight attendant does
believe me that I’m a physician, brings me over, and I meet the passenger. He’s a young guy, and he tells me that he’s starting to have
some swelling in his hands. And when I look at it,
I see hives are present. So, he’s having an allergic reaction. And he said he’s had an allergic reaction the night prior, but it wasn’t that bad. He took some Benadryl and it went away. Now, in that moment, I asked him if he had the allergy medication
still on him, and he did. He had some steroid on him,
Prednisone, and Benadryl. I instructed him to take
another dose of both and to let me know if anything at all starts happening in his mouth or throat, because that could be
a sign of anaphylaxis, which means that you have
swelling of the upper airways, which essentially, if left untreated, can lead to death, and very, very quickly. Now, you might be
wondering, what is giving Matt this serious anaphylactic reaction? He didn’t eat on the plane. My suspicion, based on talking with him and hearing his history,
he was eating a significant amount of red meat the night prior. Why is this interesting? He normally doesn’t eat red meat. He also says not too long
ago he was bitten by a tick. Now, if you’re bitten by a specific tick called the lone star tick,
which exists in the southernmost region of the United
States but now is slowly creeping its way up north, you can develop an allergy to red meat,
specifically to alpha-gal. This is a sugar molecule that’s found in some mammals, but not people. And once you’re bitten by this tick, if you eat an animal product
that has alpha-gal in it, you can have a delayed allergic
reaction much like Matt had. I right away started thinking
worst-case scenarios. What’s gonna happen if
his throat starts swelling and we’re over the Atlantic Ocean? Well, we can’t land, so I would have to administer epinephrine, which is essentially just adrenaline. And we give this medicine
into the upper thigh, into the muscle, in order
to relax the airways, to tense up the blood
vessels throughout the body so that we don’t lose blood
pressure, which is one of the really dangerous parts
of anaphylactic shock. If the epinephrine or
the EpiPen does not work, the next step would be
to schedule a landing. And if the swelling
continues to get worse, I would be forced to make an incision in this young man’s throat. I started panicking. I haven’t done this procedure
since medical school. I haven’t seen it performed in years. I tried connecting to
the wifi to watch videos. I have no shame in saying this because this is not a
procedure we do anymore. We intubate patients. But to do what we call a
cric, that’s serious stuff. That’s what you see on Grey’s
Anatomy and House episodes that we laugh at and say,
oh, no one ever does this. So, I was trying to
brainstorm what I can use in terms of tools on the
airplane to make this incision. I was saying maybe a pen, maybe
a needle, maybe one of the ampules that were found in the
kit that were made of glass, and I could use a sharp piece of glass. My mind was racing. A few minutes later, the flight
attendant comes and gets me and says, “Okay, he’s starting
to have oral symptoms.” And that’s when I kick into my medical mode, full-on medical mode. I rush over, I look at his throat. It is definitely swelling. I can see it swelling. I just make the decision
to rush him to the front of the plane, right by the cockpit, and it allows us to get some privacy, ’cause I was gonna ask
him to take off his pants in order to give him the injection. When I break open the kit that was found on Delta’s plane, I was shocked because on the outside of the
kit, it said epinephrine. There were no EpiPens. Now, you might be thinking, well, if there’s epinephrine,
what’s the big deal? You have epinephrine. It can be used just like an EpiPen. Well, yes and no. While it’s the same active ingredient, the dosages are different. Normally you give either .3
milligrams or .5 milligrams during an anaphylactic reaction. With an EpiPen, that’s
already pre-administered and pre-filled with the
needle in it and everything. Now, what was in Delta’s
kit was an epinephrine injection kit for cardiac arrest. That’s when someone’s heart flat-lines. You’re not shocking a patient. You’re giving them this
dose of epinephrine. This is much higher dose. It’s one milligram. And the needle is an inch and a half long. And I knew this was gonna be painful. So, here I am reading the instructions on how to get the needle free, because this isn’t a kit
I was familiar with using. So, I was fumbling with it for
the first 30 seconds or so. That’s why we need to
have an EpiPen on board. Because an EpiPen, had it been there, all you have to do is read the instructions really quickly,
boom, it auto-injects. It’s simple. I told the patient what we’re gonna do, I guess the passenger,
told the flight attendant, and I injected it because his throat was really starting to swell. He started screaming. I immediately withdraw the needle. I hand him an alcohol pad and I ask him to hold pressure so I didn’t
get any of his blood on me. He starts telling me that the area’s becoming very tender,
and I understand why. One of the main mechanisms of action of how epinephrine works
is vasal constriction. It makes the arteries clamp down. That raises the blood pressure and allows the person to live. But also, if you’re giving it in this area and it tightens all the blood vessels up in this area, it causes a lot of pain. So, right away I explained
to him what was going on. I had him take a few steps
to walk around, got some ice on his leg just to make
the pain a little bit less. We’re checking his pulses,
checking his vitals. The reason why when you
administer epinephrine or an EpiPen the first
step we do afterwards is to get you to a
hospital is for monitoring, to make sure that, A,
the allergic reaction doesn’t come back, B, to make
sure that your heart is okay because I’m giving you adrenaline. That not only speeds up the heart, raises the blood pressure. It can cause all sorts of side effects. So, now above the Atlantic
Ocean, the pilots are asking me, the flight attendants are asking me, should we land in Canada? Should we go back? Should we land on the
islands near Portugal? I ask the head flight
attendant, who was super sweet, to ask ground control
what their policy was. And what she told me Delta told her, as long as a doctor was in
control of the situation and felt the patient was stable, no emergency diversion was needed. So, I checked his vitals a few times after doing the injection. He was tachycardic as a
result of the epinephrine. His blood pressure was stable. It was in the normal range. It wasn’t dropping. And we made the decision
to continue on route to Tel Aviv, Israel, but
continually monitoring his status. I took out my iPhone. I was looking in his throat just to make sure it wasn’t swelling. Because he did scare me a couple of times. He couldn’t tell if it was just very dry or starting to swell. Whenever you get a dose of adrenaline, I guess think about if
you’re making a speech and you’re doing public speaking. You get nervous, you get dry mouth. That’s the adrenaline kicking in there. So I thought that that’s what likely was going on because when I looked with my iPhone, I did
not see any swelling. Everything looked okay. There was no need to
give a second injection. So, what my job was once
we gave the injection was to, A, keep the patient calm, and to check his vitals to make sure there’s nothing bad
changing, his blood pressure wasn’t dropping, his pulse
wasn’t going too high, and we could continue on with our flight. I did this pretty much every 30 minutes, talked to him, stood over him. And at one point, he became really tired because he took several doses of Benadryl, Prednisone, adrenaline. He was getting sleepy ’cause he didn’t sleep well the night before. So, after watching him for
about four or five hours after the injection, I felt comfortable returning him to his seat,
telling his counselors and people that he was on the trip with about what was going on, that
if anything were to change to right away come and get me. But my plan was to put him in his seat for the last two hours
and every half hour or so come on and check on him and
do another round of vitals. I did that up until the point of landing. His vitals were great. He was resting, his
throat wasn’t swelling, his pain in his leg was even resolving. So, we’re able to land the plane and he survived this transatlantic flight. The passengers around me thanked me, but they didn’t thank me for
saving this young man’s life. I guess they didn’t
know what was going on. They thanked me for not diverting the plane and ruining their plans. I thought that was pretty funny. The crew on the plane were amazing. All the pilots, flight attendants, they actually wrote me
a nice thank-you card for the attention that I gave Matt. I was nervous, I was sleep-deprived, but I was also very happy
that we had a good result. What makes this story kind of come full circle is really interesting. There’s a company called Taglit, which does birthright trips to Israel. And that’s the trip that Matt was on. He was going to explore
Israel with his group. I actually was on the
same trip 10 years prior. And they said, well,
we have to connect them somewhere where we meet on this trip. He was gonna be in Jerusalem. I was gonna be in Jerusalem. We had to have a meetup. And what do you know? We made it happen. I was in a hospital in Jerusalem doing some talks with one of
their university researchers and touring their hospital,
and we found Matt there. He was already discharged,
but he came to visit. We’re able to say hi, get a good laugh. I was able to see that
he’s perfectly fine. His leg is not bothering him too much, he’s touring all around
Israel doing hikes no problem. Now he’s carrying an EpiPen around to not repeat this experience. How is it possible that airlines don’t have EpiPens on board? Allergies, anaphylactic attacks are on the rise all throughout the world. We should be having
EpiPens available so that the flight attendants could
be trained on how to use them, and they can hopefully
save someone’s life. I looked up if this has ever
happened before, and it has. Luckily in those situations,
another passenger had an EpiPen on board, and
they were able to use theirs. But relying on that is not smart. Relying on the fact
that there’s epinephrine for cardiac arrest on the
plane is also not smart. Easily in the haste of an emergency, someone’s gonna take that,
administer way too much of a dose, and the person
can die as a result. My message to airlines? Do what you have to do to
get an epinephrine pen, specifically an
auto-injector pen, on board, update it every year or 18
months so it doesn’t expire, and you’re gonna save people’s lives. I think this is just a no-brainer that we absolutely have to accomplish. This story was obviously a crazy one. I don’t know if I’m ever gonna have a story time to top this one. If you wanna hear about
my journey to Israel and all the amazing things I
was able to accomplish there, drop it down below in the comments, ’cause I desperately
wanna tell you about some of the amazing breakthroughs
they having going on there. And definitely click this video
’cause it’s worth watching, and I know you’re gonna love it. As always, stay happy and healthy. – Thank you, Dr. Mike. I really appreciate your help, man. (relaxing electronic music)

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