During my one week break from uni, I was on my way to a family reunion overseas. While flying from Sydney to Hong Kong, I heard the PA announce that a doctor or nurse was needed to help with a situation. Immediately I wanted to go up and help, but I also doubted my own abilities as I'm just a first year medical student that hardly learnt any pathologies/treatments. I recalled the PBL session regarding medical attention on the plane and recalled a 'fact' that there is statistically a doctor on every plane and I thought I'd better leave it up to the doctor.
While I was battling between my urges, two pages have gone by. After the third page, I summed up the courage and told the staff that I am a medical student/pharmacist and I would like to help. I made sure I clarified that I was a first year medical student and was not capable of diagnosis or prescribing treatment.
As I walked up the aisle to the patient, I remember that I was both really nervous and excited at the same time. My own heart beat was palpable and when I stood by the patient, I could feel my legs weaken and shake.
The patient was a 63 y.o female that had fainted and lost consciousness for 10 seconds when trying to stand up. She was travelling with her husband and had collapsed on his lap. She had spontaneously recovered. A registered nurse was currently with her and was measuring her blood pressure. He reported that she had no current medical conditions (specifically diabetes). Her pulse was 70 and regular, BP was around 110 for systolic, but could not hear diastolic possibly due to loud conditions on the plane and also a bad stethoscope. (I should have brought my stethoscope! Darn!). She took some medicines such as pantoprazole and a drug which I did not recognize the brand name of (they said it was a type of antidepressant).
I asked the patient and found that she did not have any chest pain. This was not the patient's first time fainting but it was her first in a long while. She used to when she was young. She also said that her daughter also had just delivered a child, and thus the patient may have felt a bit emotional.
The nurse had already recommended her to keep her feet up and lie down. He also recommended her to drink plenty of water. She was also given an oxygen mask to breath through.
By this time, a doctor of Chinese medicine arrived and started examining the patient. Soon an ICU nurse arrived on scene too. They all examined her and decided that her condition was stable and she looked fine.
From her symptoms, I think it was likely a vasovagal syncope. I checked that her hands were warm and well perfused, and her general appearance looked stable. I asked was there anything I could do to help, and both the patient and her husband said they're fine.
As a medical student, the situation made me feel nervous and my lack of experience worried me a lot. I admit that during the examination, I could feel my legs getting weak due to nerves. Luckily we had learnt about syncope, and the common causes of it. From my knowledge common causes of syncope are hypovolemia, anaemia,vasovagal and hypoglycaemia. Life threatening causes of syncope include arrythmias, pulmonary embolisms, hypertrophic cardiac myopathy and cardiac tamponade.
From the symptoms, we could rule out hypoglycaemia, and arrythmias. From her appearance she did not look distressed and with warm hands does not suggest any form of shock. I knew it was beyond my training to rule out the cardiac causes as I did not know how to detect a PE.
I would have liked to take a thorough history as I do not know if she had anaemia, nor did I ask for any symptoms during the unconscious phase such as twitching or incontinence. I felt that the other professionals must have gone through a lot with her, and I did not want to possibly bother them as I was just a med student. Maybe this isn't the right thinking,as it is crucial to pick up vital symptoms that other people may have missed. In retrospect, maybe I should have performed a cardiac examination, but I was not confident in my skills to pick up anything.
On the whole, I am glad I volunteered. The experience was invaluable. One thing I learnt is to pay attention in class! You never know when you need to help out!
Post note:
Regarding the Chinese practitioner, I couldn't help but feel confronted when her treatment strategies conflicted to what I was taught. Her management of syncope by pressing vital acupuncture pressure points made me feel that it was neglect to the patient if the condition was sinister. I find this interesting as I come from a Chinese background, and have always had thought that Chinese medicine or herbs and acupuncture works. But yet I can't help feel confronted by the doctors symptom management plan. In my mind I guess I didn't consider her as a doctor.
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