174. Primum Non Nocere, Part Two

Well, we made it to Singapore.  By arrival, his blood pressure had decreased slightly, to about 219/118, and his oxygen saturation level remained at 100%.

A medical team was waiting for us, but initially couldn't even make it up the aisle because the minute the plane stopped, passengers filled the aisle, pulling down suitcases, ignoring the flight attendant's timid request to remain seated.  So I stood up and very loudly (but not to the yelling state) said, "Everyone please sit down to make room for the medical team. This is a medical emergency."  That did the trick.

The medical team had three people, with a stretcher and a medical bag. A young man in an impressively neat, tailored white shirt and tie, presumably the equivalent of a paramedic, was clearly in charge.  I told him what I knew, and he proceeded with an initial assessment of heart and lungs then quickly inserted an IV (just like in the movies). 

Then he opened up the defibrillator kit (which can provide an electric shock to convert arrhythmic heart patterns to normal rhythms, arrhythmia a common consequence and/or cause of cardiac arrest).  But wait: he has a normal pulse, is breathing regularly, and is fully oxygenated (so clearly the heart and lungs are doing their jobs).  So why the defib? The defib routine begins with electrodes that are placed on the chest to provide an analysis of the heart's rhythm. Though skeptical of the need for this (why delay the transport?), I grant that uncommonly an arrhythmia might be present but undetected by a stethoscope exam (not that he asked for my opinion).

If the defib machine were to pick up an arrhythmia, it would verbally prompt the medical attendant to push a button to administer a shock.  In this case, with a normal heart rhythm demonstrated, the verbal prompt instead said, "begin chest compressions." Having just confirmed a normal heart beat, why would the machine's algorithm do that? Anyway, the paramedic knew more than the machine--that the patient's oxygen levels were normal. But he followed the machine's instructions and started chest compressions. Chest compressions are not harmless since ribs can be broken, and of course the continued delay.

Fortunately, he soon gave up on this and the patient was put on a stretcher and taken to a hospital, where he probably received a head MRI--when I later talked to an ER doc in my clinic, asking what he would have done, he just said, a head MRI, as soon as possible.

I headed for the terminal, wondering, as is my nature, if I could have done anything different.