Airplane Medical Emergency | WE COULDN’T LAND! | Wednesday Checkup
15
October

By Adem Lewis / in , , , , , , , , , , , , , , , , , , , , , , /


– 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)


100 thoughts on “Airplane Medical Emergency | WE COULDN’T LAND! | Wednesday Checkup

  1. There's a company that is trying to develop fast dissolving epinephrine tablets to stick under a person's tongue, which would be great for situations like this. Unfortunately, the company still have to do more tweaking before it would be available because while they do dissolve and absorb into the oral mucosa, they caused the tongues of the rabbits they were tested on, either to swell or the outer layers of the tissue on the tongue to slough off

  2. I don't find it funny at all that passengers were thanking you for keeping the flight on schedule. If someone's life is at stake I'm okay with figuring out flight issues and other first world problems. People suck.

  3. Hello doctor mike I'm so happy that their are people like you in the world so they can make a different in the world you go man go

  4. No Epi Pens because the price has skyrocketed to a completely unreasonable amount. I’m an EMS provider and my organization switched to carrying amplules and syringes for manual IM injections.

  5. PROBLEM IS! EPI PENS ARE LIKE $1500 dollars in USA!!! If I use mine on you…. (I don’t have one or need one personally) then I’m out $1500?? That’s what’s messed up. XO

  6. 8:02 "I felt comfortable telling his counselors and the people he was on the trip with—" In that moment I immediately knew it was a birthright trip.

  7. I feel like at least one person on the plane would have had an epi pen 🤷🏼‍♀️ they should have made another announcement or smthn

  8. But did you have them ask if any of the other passengers carry an epipen? I always do because of my allergies and it has come in helpful for someone else having a reaction before

  9. Can you PLEASE make a video about Israel, I'm from Israel and very curious to know about your trip. Also LOVE your videos they always put a smile on my face❤️

  10. That boy is so lucky that ur in the plane Dr. Mike. He still have the 2nd chance to live. Kudos to you doc. ☺️😍👍😘👏👏👏

  11. anaphylaxis is not fun at all; I developed an allergy to bees after being stung by a tarantula hawk wasp it's 0% fun and 100% serious and quick

  12. My brother is a doctor and he had to show his ID to prove he is a doctor when they asked if there was a doctor on board his flight because he looks so young (he was over 30). It was just food poisoning but he ended up getting a letter from the airline doctor and a bottle of champagne as a thank you.

  13. Question: if you have an epi pen and it's expired … Should you still use it? I have a severe allergy to bees, thankfully I live in Alberta sooo most of the year they ain't around and I do get a new $100 dollar epi pen every year …. Ugh … But if I was in a situation where I didn't have mine, or maybe it was expired, I have about 15 minutes to where my throat is pretty much completely closed and I'm done. Anyone? Btw … Dr Mike is Canadian?

  14. I remember one time I had an allergic reaction and it hurt when I was walking to the door to a hospital after an EpiPen injection. Now I posses the ultimate knowledge of why it hurt

  15. I remember working at a camp and every single time we had a camper who has had seizures in the past and we were at the water front I was always half in rescue mode because I know I would need to grab this child and get them to the dock/land as quickly as I can.

  16. "Is there a doctor on board?!"

    *Dr. Mike comes stumbling down the isle, no shoes, hoodie, lookin like he hasn't slept in 40 years*:
    "YOU GOT THE TICK MEAT ALLERGY PAL, IM GONNA NEED SOME GLASS!"

  17. Am I the only one who thinks on every flight there should be a doctor or medical staff. There's alot of problems that can happen on a plane

  18. I'm at high risk of anaphylactic shocks when I come into contact with rapsberries, never had a full attack but we were pretty close to it last time I had one. I always have an EpiPen on me though for this reason

  19. As a new YouTube follower, thank you for saving his life. I've watched a few of your meme vids and TV show commentary vids. Hearing how someone was lucky to have you on a flight 💜 makes me so happy to have found your channel!

  20. 1:53 at this point it started getting so weird xD my first thought: sounds like a Dr House episode, that's amazing xD

  21. I guess this explains why there were no Epipens! They are supposed to be stocked per federal guidelines but airlines can request a waiver due to medication shortages. https://viewfromthewing.com/southwest-flight-attendant-admits-giving-worse-service-to-trump-supporter/

  22. this is the first time ive seen your video, and i must say i really appreciate your work and how professional you were handling the situation. in this case, you had to improvise and make do of your environment and materials available to you while staying under control and checking for any other risks at hand

  23. Im carrying an EpiPen from now on on airplanes. I care about people even though im in 8th grade (dont judge me) and I dont want to see anything bad happen. 🙂

  24. You need to watch the Grey's Anatomy season 13 episode 20, Meredith Grey and another doctor have to makeshift some things to help save the lives of 2 people on a plane… (then there is an actual plane crash earlier on, I'd love to hear what you would do in this situation as well)

  25. Flight attendants can’t inject anything, so if there were an epi pen you’d still need a Dr. to administer it.

    I know some airlines have a kit with intubation equipment, maybe not Delta?

    Also, typical passenger reaction to care more about a diversion than about an ill person. ¯_(ツ)_/¯

  26. So can anyone creditable answer a question I have? Basically I'm wondering if mild non life threatening Anaphylaxis is a thing? Cause I'm regularly getting unexplained hives at the moment and sometimes they will make me feel pretty weird. Just wondering if it is something I have to take more seriously.

  27. I have a strange thing that happens where if I sweat a lot I break out into hives and one time it got really bad in gym class. I was walking with two girls and one noticed my neck turning red and she was like "whoa whoa are you ok? Did you maybe eat something you're allergic to?" And I'm like "no I don't have any food allergies that i know of this just happens when i sweat." She responds with, "well i don't like this," she then pulls me over to where that water fountains and air conditioner are and tells the other girl to go get the gym teacher while she is making sure that I'm okay. The teacher comes over and asks me the same questions about maybe eating something I'm allergic to and I give the same answer that i gave the girl so she says "I don't like that your neck is turning red." So she has the first girl walk me down to the nurses office and the other girl grabs my bags for me out of the locker room. I explain the whole situation to the nurse and she decided to keep me in her office for observation in case my throat started closing and also to see if the hives went away because at that point my entire body was covered in hives. So I am in the nurses office reading and none of the hives were going away but my middle school has a policy where they will not give you stuff like benadryl without written consent from a parent or guardian so because the hives aren't going away and they are actually getting worse. She calls my mom and says "hey your daughter is in here and she is having a bad reaction to something, she says it is her sweat. Can you send someone to pick her up and take her home." So my grandma comes and gets me, gives me benadryl, and takes me over to her house so she can keep an eye on me where I watch pokemon: origins and then pass out. The next day my mom sent me in with a note saying that it was okay for the nurse to give me benadryl if it happened again. It did happen again about a month later. The gym teacher sent me to the nurse again but this time after waiting she gave me benadryl and I nearly fell asleep in every class after that.

  28. While I have never needed to use any of the epi-pens I was given as a kid, I did constantly play with the dummy pen that teaches you how to use them. Lol it's literally an epi pen sans the needle so slamming the auto injector part into your thigh was too satisfying.

  29. Benadryl has mammal biproducts, which may cause another allergic reaction. Due to this, depending on his sensitivity to red meat and animals biproducts, and it could another allergic reaction.

  30. But the real question is:
    Can you treat a cerebral hemorrhage by relieving the pressure on the brain, using a syringe, straw, and nail clippers to remove blood on an airplane in a thunderstorm with major turbulence? Because Meredith Grey can.

    Grey’s Anatomy Season 13 Episode 20
    “In the Air Tonight”

  31. Perhaps he should have made an announcement asking if anyone on board had an EPI Pen. Food Allergies are some common these days that many kids carry EpiPens.

  32. This made me think of the episode in greys anatomy where Meredith basically did brain surgery on a plane that was flying through a storm. Season 13 you have to react to that one!!!

  33. do you know how often you wiped your norse with you hand/fingers just in this video? as a German I´m very direct, sorry. 🙂

  34. Back when peanuts were still a thing on planes I witnessed someone go in to anaphylaxis. Scary part was, if my memory serves me right, they hadn't even come in contact with the peanuts. It was SO SCARY. I genuinely thought I was watching someone die. I was like eight. And we were flying from BWI to Fort Myers Florida. Everything ended up really good and we landed in Atlanta. As it was the closest and most available from where we were. It's so hard to believe planes don't have epipens. I'm curious if they did back then when they had peanuts as a snack. Because I'd not…that's STUPID.

  35. Ironically, Those Zionists, who are killing Palestinian children, women and men, bring doctors for nonprofits. What about stop killing Palestinians, then build nonprofits and bring doctors from all over the world, killers.

  36. My story: Last year I was walking to Starbucks in an airport at the very end of my preliminary year in internal medicine after a mission trip (going into Ophthalmology, so starting to adapt the mindset of lower-paced elective surgeries and whatnot), and I had *just* split ways with an IM attending who went to one of those fancy member clubs/she did not hear the subsequent overhead call. I hear the call overhead asking for a doctor urgently and happened to be walking near the gate where the incident was. It ended up being syncope with regained consciousness by the time I got there (but scary as patient was on blood thinners/had history of bypass surgery) with straightforward acute management. But man-oh-man after that feeling of being solo in an emergency situation, I will forever review the ACLS protocols/acute care no matter how far out I get from general medicine! It's an important responsibility no matter how specialized you get.

  37. OMG, poor Doc. Having to gear up for performing a makeshift cric on a plane, with little experience with the procedure. Sure, poor guy, but he's under the care of a doctor, so he probably feels as safe as he can under the circumstnaces, but poor Dr. Mike who needs to be ready for this stuff. I'm glad the guy was fine, but he must feel bummed out that he can't eat mammalian meat any more.

  38. I agree epi-pens should be in every plane restaurant hotel office building grocery store EVERYWHERE you never know when something like this is gonna happen

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