Flying Safe - Medics Onboard Qantas

[artemis]

There is always supplemental O2 on board. Any medico who knows (or more accurately remembers) about partial pressures would know that administration of O2 vs altitude is proportional anyway. RFDS or combat agency aircraft don't fly nap of the earth every time a patient has a compromised respiratory system.

edit- I wonder if the onboard kit includes O2 SAT monitor?

I recall flying back from South Africa after my trauma surgery rotation a long time ago. J on QF. Some nurse was there with a chap with a full leg cast. As an aside, she was dirty with me because I had the window seat in a 2-3-2 configuration and she wanted the pair of seats for herself and to put me into the 3 with her patient. Anyway, she pulled out a sats probe and proceeded to place it on the patient's finger. I just sat there and though "holy cow - does she have any idea?"

I mean come on - what use is a sats monitor at 30000ft for a guy with an above-knee cast? I was just hoping it wasn't a freshly applied cast that she was then going to have to saw off at cruising altitude!

 

[AVC]

I mean come on - what use is a sats monitor at 30000ft for a guy with an above-knee cast? I was just hoping it wasn't a freshly applied cast that she was then going to have to saw off at cruising altitude!

My guess is she couldn't be bothered taking a pulse and had to do regular obs. Maybe she suspected a post-op PE? Of course at 30K there's going to be some degree of desaturation, that would have her wondering.

They would have confiscated the trauma shears too....

 

[asg29e]

I mean come on - what use is a sats monitor at 30000ft for a guy with an above-knee cast? I was just hoping it wasn't a freshly applied cast that she was then going to have to saw off at cruising altitude!

30000 feet? Come on. Surely you must know that cabin altitude is in the order of 7000 feet, where you would expect a SaO2 of approximately 94% in a healthy person. I think oximetry is a very valid measurement on an aircraft no matter what altitude you are flying.

 

[sinophile888]

30000 feet? Come on. Surely you must know that cabin altitude is in the order of 7000 feet, where you would expect a SaO2 of approximately 94% in a healthy person. I think oximetry is a very valid measurement on an aircraft no matter what altitude you are flying.

Thanks, asg29e. That sounds like excellent advice. So I just bought an oximeter over the internet. I often feel really foul on longer flights when the cabin pressure drops below a certain level. Then come good as we start to descend.

 

[artemis]

30000 feet? Come on. Surely you must know that cabin altitude is in the order of 7000 feet, where you would expect a SaO2 of approximately 94% in a healthy person. I think oximetry is a very valid measurement on an aircraft no matter what altitude you are flying.

Yeah thanks. I'm fully aware that the cabin is pressurised.

Oximetry is a very poor measure of alveolar ventilation and perfusion even on the ground. The point that I was trying to make is that by all means, put the sats probe on if you want, but unless you can interpret the results AND do something about them, why bother? If you think someone is going to have some degree of respiratory compromise on a flight such that you put the probe on before take-off, perhaps they shouldn't be on a 15 hour commercial flight?

I suspect AVC was right - it was for obs. I can't remember, it was a long time ago.

 

[mattm199]

Just waiting for the PE to pass on by......

 

[asg29e]

Yeah thanks. I'm fully aware that the cabin is pressurised.

Oximetry is a very poor measure of alveolar ventilation and perfusion even on the ground. The point that I was trying to make is that by all means, put the sats probe on if you want, but unless you can interpret the results AND do something about them, why bother? If you think someone is going to have some degree of respiratory compromise on a flight such that you put the probe on before take-off, perhaps they shouldn't be on a 15 hour commercial flight?

I suspect AVC was right - it was for obs. I can't remember, it was a long time ago.

So why even mention 30000 feet?

I just think you were being a little harsh on that nurse from so long ago, a sort of "what would you know?" attitude.

As an end point to a lot of potential things going wrong, oximetry is one of the most incredibly useful observation tools around and would be one of the first bits of kit I would be looking for if I were looking after someone the least bit dodgy.

But what would I know?

 

[artemis]

So why even mention 30000 feet?

I just think you were being a little harsh on that nurse from so long ago, a sort of "what would you know?" attitude.

As an end point to a lot of potential things going wrong, oximetry is one of the most incredibly useful observation tools around and would be one of the first bits of kit I would be looking for if I were looking after someone the least bit dodgy.

But what would I know?

I was using the phrase 30,000ft as a substitute for cruising altitude, meaning that we were well into flight and probably somewhere over the Indian Ocean. That's why I mentioned it.

Because what are you going to do at 30000ft for a saddle embolus?

The implication of questioning the sats probe is that this nurse was accompanying an injured passenger. Presumably she was employed by a travel company. Is it really their policy to assess perfusion/ventilation with a sats probe on an aircraft in flight? Was this company policy? What was she going to do if his sats did drop? I was concerned that if the pax was really potentially that unwell, that there could have been a midair emergency, which would have meant I had to assist and we were flying a very long way.

And I have no idea what you'd know about any of this, since I don't know what you do. And you haven't declared it either.

 

[paxman]

Don't ever plan on having an early night if you decide to disagree with a Dr. Trust me on that one!

 

[RooFlyer]

So what happens if any two of these folks respond to the call for a doctor in flight ?

I still reckon having Anna in my corner mightn't be a bad thing

 

[legroom]

Thanks, asg29e. ...... So I just bought an oximeter over the internet....

OK, so you take it out, have a low reading ... say 75% ...., the Qs are:

1) Why do you plan to travel if you were concerned your SaO2 may drop ?

2) Would you seek a medical clearance from the airlines were that the case ?

3) Would you seek permission for portable O2, assuming that it is possible to do so ?

4) Would you need to travel with an ED nurse (and an intubation kit) ?

I'm intrigued - without wanting to know the personal details, of course.

Qantas policy is here (http://www.qantas.com.au/travel/airlines/oxygen/global/en).

Don't ever plan on having an early night if you decide to disagree with a Dr. Trust me on that one!

Sometimes, there are equally valid options and you have the right to make an informed decision to take a different option. That won't be any issue.

When the indication is otherwise clear cut for a course of action, but you decide to listen to your iridologist's advice.... We tend to remember those ones.

 

[sinophile888]

OK, so you take it out, have a low reading ... say 75% ...., the Qs are:

1) Why do you plan to travel if you were concerned your SaO2 may drop ?

2) Would you seek a medical clearance from the airlines were that the case ?

3) Would you seek permission for portable O2, assuming that it is possible to do so ?

4) Would you need to travel with an ED nurse (and an intubation kit) ?

I'm intrigued - without wanting to know the personal details, of course.

I have never known what my sats levels are when flying, but just know that I often feel shocking. My initial response is to walk around for a while, when possible. Even chatting tends to make me feel a bit better. Next step is to set up my CPAP machine as I find this also helps. I always restrict my flights to daytime and try for under 5 hours.

I have had arrhythmia problems for the last 14 months so no flying at all since November 2013. All is under now control (touch wood) so I am looking at a test flight to Melbourne in the next few months, then possibly Singapore. I want to get back to China asap, but need to have these trial runs first so my husband doesn't freak out.

Thank you for your concern.

 

[JessicaTam]

I have never known what my sats levels are when flying, but just know that I often feel shocking. My initial response is to walk around for a while, when possible. Even chatting tends to make me feel a bit better. Next step is to set up my CPAP machine as I find this also helps. I always restrict my flights to daytime and try for under 5 hours.

I have had arrhythmia problems for the last 14 months so no flying at all since November 2013. All is under now control (touch wood) so I am looking at a test flight to Melbourne in the next few months, then possibly Singapore. I want to get back to China asap, but need to have these trial runs first so my husband doesn't freak out.

Thank you for your concern.

I hope you get back in the air sooner rather than later.

 

[sinophile888]

I hope you get back in the air sooner rather than later.

Many thanks , JessicaTam. You seem to be a very nice person and an excellent Moderator.

 

[artemis]

So what happens if any two of these folks respond to the call for a doctor in flight ?

I still reckon having Anna in my corner mightn't be a bad thing

I can assure you that if I'm attending you midflight, the sats probe is not going to be my highest priority. History and clinical assessment. It's seen all too often that people rely on their (unreliable) instrument readings rather than looking at the problem in front of them. In fact, there's another great aviation/medical parallel!

I have never known what my sats levels are when flying, but just know that I often feel shocking. My initial response is to walk around for a while, when possible. Even chatting tends to make me feel a bit better. Next step is to set up my CPAP machine as I find this also helps. I always restrict my flights to daytime and try for under 5 hours.

I have had arrhythmia problems for the last 14 months so no flying at all since November 2013. All is under now control (touch wood) so I am looking at a test flight to Melbourne in the next few months, then possibly Singapore. I want to get back to China asap, but need to have these trial runs first so my husband doesn't freak out.

Thank you for your concern.

Whilst I also hope that you have a speedy return to the skies, I do hope you seek the appropriate clearance from the various specialists. You may find your respiratory physician can simulate a reduced pressure environment to predict how you will react. I would hate for something to happen to you that could have been avoidable, though I do understand the lure of China!!


I wonder whether passengers are liable if they travel knowing that they have a medical condition and cause a mid-flight diversion. Perhaps one of the lawyers can chime in again...!

 

[sinophile888]

Whilst I also hope that you have a speedy return to the skies, I do hope you seek the appropriate clearance from the various specialists.

Even whilst I was having fortnightly to monthly cardioversions, my cardiologist assured me that I could fly to Melbourne, Singapore and Hong Kong. Or anywhere where there were appropriate medical facilities. I even priced a cardioversion in Singapore, S$2700. After the ablation, the electrophysiologist said the same. But as well, I could not go on a cruise for 2 years and I could never go to America.

My only issue now is that I cannot find travel insurance, so OS travel is out for the time being.

 

[paxman]

OK, so you take it out, have a low reading ... say 75% ...., the Qs are:

1) Why do you plan to travel if you were concerned your SaO2 may drop ?

2) Would you seek a medical clearance from the airlines were that the case ?

3) Would you seek permission for portable O2, assuming that it is possible to do so ?

4) Would you need to travel with an ED nurse (and an intubation kit) ?

I'm intrigued - without wanting to know the personal details, of course.

Qantas policy is here (Oxygen).



Sometimes, there are equally valid options and you have the right to make an informed decision to take a different option. That won't be any issue.

When the indication is otherwise clear cut for a course of action, but you decide to listen to your iridologist's advice.... We tend to remember those ones.

Sometimes there is breakfast and sometimes there is a Dr left afterwards. I leave it up to them.....

 

[AVC]

It's seen all too often that people rely on their (unreliable) instrument readings rather than looking at the problem in front of them. I

Indeedy. We call it being "machine oriented". And yes, the aviation parallel is so true.

Interestingly, if a passenger has a need to carry their own O2, and let's say they are carrying a typical C size cylinder, even at a low flow rate of 2l per minute with prongs, said cylinder wouldn't last a long haul. Although at altitude the lower cabin pressure would make the cylinder last longer.

 

[PaulST]

Anyway, she pulled out a sats probe and proceeded to place it on the patient's finger. I just sat there and though "holy cow - does she have any idea?"

I mean come on - what use is a sats monitor at 30000ft for a guy with an above-knee cast? I was just hoping it wasn't a freshly applied cast that she was then going to have to saw off at cruising altitude!

I'd speculate she was attempting to justify her business class flight... And couldn't be bothered palpating the heart rate.

Thanks, asg29e. That sounds like excellent advice. So I just bought an oximeter over the internet. I often feel really foul on longer flights when the cabin pressure drops below a certain level. Then come good as we start to descend.

I'd avoid an Sa02 monitor to be honest. Often the machine fluctuates in its accuracy which may give a falsly low figure and all that'll do is give you a fright. Machines are good but can cause more problems in unqualified hands ( mean that in the nicest way possible ). Best you have a good chat with your doc.

 

[asg29e]

Indeedy. We call it being "machine oriented". And yes, the aviation parallel is so true.

Interestingly, if a passenger has a need to carry their own O2, and let's say they are carrying a typical C size cylinder, even at a low flow rate of 2l per minute with prongs, said cylinder wouldn't last a long haul. Although at altitude the lower cabin pressure would make the cylinder last longer.

I'm sorry, that last sentence is just not true. Without going into the physics of laminar vs turbulent flow, almost all mechanical flow meters that are calibrated for sea level will under read at altitude due to the decreased density of the gas interacting with the bobbin or whatever flow sensing mechanism is there. Yes, the gas has also expanded but the net result is that your bottle will not last longer. In fact to keep the inspired oxygen partial pressure somewhere near where it was at sea level an increased flow rate may be required. There are ways around this, using pulsed electronic delivery systems but this is getting way OT.

My advice to anyone looking for medical advice re flying is: don't look for it on this thread. It may all be well meaning but is not always accurate.

Of some concern also is the "anti machinery" flavour of some recent posts. Clinical skills are to be applauded, but time after time it has been demonstrated that even in perfect light a pulse oximeter will detect subtle levels of cyanosis much more accurately than the most experienced clinician. And with the light available down the back of a 747, clinical assessment of cyanosis is just a guess. My advice to medicos who are called to assist is: put that damn oximeter on. It takes 2 seconds and you may discover something your excellent clinical skills have missed.