In-flight surgery with a coat-hanger and silverware
en.wikipedia.org
en.wikipedia.org
I fit the 5'9", young, male, otherwise healthy group described here.
https://en.wikipedia.org/wiki/Precordial_catch_syndrome
Very similar symptoms, totally harmless, to the point where the recommended treatment is "reassurance". As long as the pain lasts for less than 3ish minutes, you have no reason to panic.
(I used to get very anxious every time I had these symptoms, after a friend of mine in high school described the same experience as the others in this thread, trying to sleep off the pain and ending up hospitalized for a collapsed lung. Learning about PCS really put my mind at ease)
First of all, it is usually brought on by sitting hunched over and breathing shallowly for a while (like, an hour). And the pain isn't exactly stabbing, unless you're counting being poked hard with a Popsicle stick.
It releases if I breath deeply enough, with an odd crunching sensation, sort of like popping really small bubble wrap, or cracking knuckles on a tiny hand.
I just stretch, breath deep despite the pain and sleep it off. It... usually goes away within a day or two. The reason why I've always taken this approach is because it was always just growing pains or my ribs pinching me somehow. (Apparently that's a thing.)
That all said and done, the last time it happened I was genuinely curious and concerned, cause the last time before that I had it happen was years and years ago. And I'm not exactly growing anymore, etc. Not precisely.
But yeah. 5'6, still young-ish, and otherwise healthy I think.
Even a spontaneous primary pneumothrax must be handled seriously. It can become life threatening.
I'm very glad they did a pleurectomy both times instead of pleurodesis; I've heard people describe pleurodesis and it's pretty terrifying, both the recovery and the permanent after-effects. Noticeably reduced breathing capacity isn't uncommon.
People think it's related to body type, but the surgeon said the more modern understanding is that it's due to "blebs" (actual medical term) on your lung that burst - which the pleurectomy removes. Pleurodesis is usually unnecessary in young people. I was more prone to blebs due to a genetic syndrome.
I've had a pleurodesis on my left side. I never noticed any reduced breathing capacity. The procedure left a few stab-like incisions scars but I actually like them. I'd feel safer if the same was did on the right side too; I like the idea that it will never happen again on the left side but hate the feeling that it can happen again at any time on the right side.
I don't know if the procedure I was submitted is the most common. The surgeon described that they burned (cauterized, I think) the pleuras with an electric scalpel. As it healed, the pleuras stuck on one another. It was painful for just a few days but analgesics were enough to make it bearable.
There was one strange effect: it numbed the tactile feeling of parts of my breast, chest and arm. Immediately after the surgery the numbing effect was so intense that I could pierce the skin with my nails until it bled and felt not pain. I actually did it to demonstrate how numb it was. The medic said it would improve over time. It took years to get the feeling back. It's been twenty years and the feeling still is a bit numb.
Was a little unsettling.
They did the first round of X-rays and were about to let me go since there's not much they do with ribs and collar bones these days. The last minute the Doc came back in and told me that breaking my first rib is pretty difficult and they wanted a few more X-rays which is when they found my pneumothorax and shit hit the fan. I was suddenly in a neck brace and had a Doctor shoving a tube into my chest and had to spend three days in a trauma ward to make sure everything was okay.
All this being said, I knew I had a broken Collarbone right after the fall, but outside of that I literally rode my bike three miles off the hill and drove home for an hour and walked into the ER, and was about to leave feeling fine. It's somewhat "common" for these to be missed after traumatic accidents - though most ER's know to look for them.
It's been a long time since I did the course as I went a few years without having to travel to the kinds of places where it's likely I'd need to apply it, but I do remember a plastic bag and vasseline was recommended if you didn't have a magic sucking chest wound plastic cover thing with a valve on (our med kits contain things like that and tourniquets as well as the usual stuff - including packs of sterile needles etc).
“It’s my right, your left” (not common but has occurred multiple times).
The more frequent one is where someone is trying to say “medial side of left leg” and say “it’s the right side of of my left leg”.
It seems dumb but if it saves me from having someone dissect my right knee when I wanted someone to bolt a new AC ligament into my left one, I'm all for it.
Anyway, I want to discuss two specific things.
1) At the time, being a young college student, I pigged out on junk food, often popcorn that I would pop in a pot using oil. I came to associate my cooking popcorn in this way with pneumothorax occurrences.
2) I was tall and quite underweight. I'm wondering if other young people who had spontaneous pneumothorax tend to be shaped similarly.
Oh. Never mind.
After that, the surgeon would have to contend with malpractice concerns while the patient healed from two holes in their chest, one unnecessary.
Sometimes it feels like a time bomb. I've been living with it for so long I just don't care anymore, it actually makes no difference in my life or plans. It prevented me from becoming a military pilot though.
Before you go, they do as much as possible to ensure you won't have medical issues once you get there. One of the things is that they strongly suggest you get your wisdom teeth taken out. The guy I know did so a few weeks before leaving.
It turns out that his dentist was less than competent and he left parts of the tooth in the gum during extraction. So he gets to McMurdo, starts having really bad pain in his mouth, goes to the doctor and is told that his mouth is infected and teeth will need to be extracted.
The doctor reassured his patient with the words "Don't worry! I once took a one-day course in dentistry!"
That seems to fall under the "If it ain't broke, don't fix it" category -- if he was an adult with no prior issues from his wisdom teeth, he'd have been better off either leaving them alone, or having them removed 6+ months prior. I'm surprised they let him do it just a few weeks ahead.
More info: https://books.google.com/books?id=sR5Cm_zeIekC&lpg=PA84&ots=...
The airplane guy had more complications than ruptured lung but apparently he had just came out of scuba diving into the plane.
https://en.m.wikipedia.org/wiki/Leonid_Rogozov#Antarctic_ser...
https://www.narescue.com/ars-for-needle-decompression-3-25-i...
https://en.wikipedia.org/wiki/Thoracentesis
Would have been much easier than using a coat hanger and silverware if they had it on board, already pre-sterilized…
So more than likely they were aiming to intervene before it needed to be a needle decompression. But also, they were probably thinking this is going to be a ripper of a story and we've got the skills to pull it off
When I read it initially I thought - that makes sense, but I just did the equations, and basically the thing you're worried about is that the pocket of air that is outside the lung is going to change volume significantly and lead to the worst case outcome, a tension pneumo.
But the volume of air outside the lung is going to be at cabin pressure, since that's where it developed. Cabin pressure is ~75kPa. Ground pressure is ~100kPa. The lung is going to exert more pressure than the gas so if you plug all that into boyle's law then you get a 75% reduction (or actually, you don't need to plug it into a calculator, because if you can't work out the percentage of 75/100 you're in trouble, so zero points to me). which would improve/stabilise. However maybe they were concerned the change in pressure could lead to a disequilibrium between lung pressure and potential space (of which there is always some due to breathing, and that sucking pressure into what should be a vacuum is what caused the pneumothorax - air leaking through a disruption in lung tissue) - and because the pressure differential is in favour of a flow into the low pressure zone, and that differential has increased, they're worrying about it shifting materially in a matter of minutes which could get bad quickly (particularly when you consider the potential for any leakage to become progressive, rather than, say, self-limiting)
I don't know enough of this sort of edge case medicine to make any sort of definitive statements but if that was the physiology, maybe they decided it was out of the question to risk it
---
I just realised I didn't really answer your question - which relates to, i guess, basically being at cruising altitude as it develops. Because it's steady state (ie inspired air/atmospheric air is going to end up similar pressure to trapped air) basically not significant in terms of progression until you get to blood oxygenation thresholds - because there's a lower partial pressure of O2 in cabin air compared to on the ground, the decreased lung volume is going to cause these issues to become apparent more rapidly.
So it shouldn’t affect progression/growth of the pneumothorax, but it will exacerbate the physiological deterioration
cracks knuckles
"time to open up west's respiratory physiology again"
Thats actually not the use here but that meaning is common. “Emerge” is simply Frenchified Latin for ausgehen.
In this case however it appears to be medical (perhaps ER) slang for “rapidly becoming an emergency”
Chronic => continual/frequent (chronos?).
Emergent => sudden (emerge?).
"Emergency Care" => "Sudden Care".
Urgent => important (urge?).
It finally made a lot of sense realizing that an "emergent condition" is something that "comes out of nowhere" and is potentially rapidly changing. Versus "urgent care" as "something that should be taken care of promptly".
I assumed emergent means „rapidly increasing numbers of“ and not „ Arising suddenly and unexpectedly, calling for quick judgment and prompt action.“.
The title of the publication makes it seem as if this in-flight surgery with a coat-hanger is a routine occurrence. Remarkable!
> I found her sitting on the toilet with the underwater seal drain on a high shelf. All the water and air had syphoned out of the bottle into the chest. The crisis resolved when I placed the underwater seal drain on the floor—draining the water back from the chest to the bottle. The air bubbled out of her chest when she coughed. After a few minutes she was almost back to normal, but exhaustion precluded the completion of a third full medical report.
So now my taxes paid for the garbage public healthcare system that I didn’t want, and then I had to pay for the private insurance.
Unfortunately most people aren’t that fortunate to be able to easily justify spending extra £300 a month on health insurance so they just cope with the NHS.
Something a little similar happens in the US: as a visitor you can get travel insurance including private medical care for much less than regular private insurance, because the insurance company isn't on the hook for long-term problems, just for a medevac back to your home country.
It’d be NHS if the non-urgent treatment would be immediately available from them (which is basically never), otherwise I’d be sent to a private hospital.
> Or maybe the existence of NHS puts healthcare costs much less than that in the US.
This probably helps, but the US healthcare costs are just fucked for no good reason. I like to look at South Korea as an example of reasonable costs in a healthcare system that’s 100% private (the government just picks up the tab afterwards).
Amen to that.
> I like to look at South Korea as an example of reasonable costs in a healthcare system that’s 100% private (the government just picks up the tab afterwards).
From Britain you don't have to look that far abroad for this: Germany would suffice, AIUI, or maybe even just across the Channel to France. (But, hey, congrats on leaving the club of civilised nations.)
Tones of people fly to India to get major surgery done , medical tourism is a booming industry there.
For a British resident it wouldn't be even a factor on the top of the mind as they would be used to NHS covering everything and most people would expect travel insurance to cover this - it probably would have
[1] even in 1995
That being said, from a global perspective, “bankruptcy” is not a good measure of economic burden. There are worse debt outcomes than bankruptcy.
Bankruptcy is not some sort of a financial death sentence. In fact you’ll even be able to get access to credit almost immediately, because the default risk just after bankruptcy is extremely low due to the fact that you can’t declare bankruptcy for another 2-3 years.
Yes, your credit score is trashed for the next 6-7 years, but it’s also trashed with an insufferable amount of medical debt.
I would be much more upset about a 6 figure medical bill if I had 6 figures in liquid assets than I would be if I owned nothing besides some home equity.
If I have 6 figures of liquid assets, I’m wiped out, but if I own nothing, I declare bankruptcy and have a clean slate.
Not only do you get to keep your home, but the majority of people who file Chapter 7 keep everything.
That’s not to say we don’t have issues with medical costs… I’m just speaking generally about using bankruptcy rates as an indicator.
The TL;DR is that the law allows you to “exempt” certain assets, mostly, basic necessities that people need to live a basic productive life. The point of bankruptcy is to make people pay what they can reasonably afford, not to make them pay every penny possible. The types of assets that chapter 7 does take away are things that poor people often don’t have anyway.
https://www.nolo.com/legal-encyclopedia/what-is-chapter-7-no...
I think TV and movies have led people to believe that people “lose everything” when they file bankruptcy and end up on the streets. That’s just not reality, at least in the US.
And sure, fly another 1-2 hr to get to the final destination, but they flew 8+ hours.
It kinda makes no sense.
An in-flight surgery that stabilizes the patient indefinitely is more successful IMO than one with all the best tooling that gets the patient killed.
Infection is not an automatic outcome. My grandma was an obstetric nurse, she witnessed surgeons in 1950s Southern Italy performing operations with rusty knives; and most patients would still be ok.
Sometimes we forget that the human race survived for thousands of years without the niceties of modern medicine. It's good to minimise risk, but in the end risk does not mean certainty of bad outcomes.
It needs to be 70%.
https://www.cdc.gov/infectioncontrol/guidelines/disinfection...
If all you have to disinfect your ad hoc instruments is brandy, then use it: way better than nothing.
I've never quite understood that. But there has been a lot I don't understand these past few years.
The attempt to conceal comment seems to be doctor covering his errors after an inadequate physical exam before take off.
Someone trying to conceal wouldn't complain of chest problems before take off. Most airlines would remove you from the plane before even doing an exam, and won't depend on eye doctors potentially flying to do it.
He's saying that the water bottle was draining fluid from her chest, but she/someone put the bottle on a high shelf, so it drained back into her chest.
This is why you don't immediately leave post-operative patients to take care of themselves.
Literally NOT a post mortem
"Hero doctors save woman / Surgery ON A PLANE [ambulance called] [near-death]"
Some AI papers like the Yolo ones are ever so slightly like that already... maybe it's a matter of time.
My sister is training to be a doctor and she has come to dislike the heavily regulated environment we have here in which doctors are not allowed to do anything of this sort. Now, they also don't usually need to, which is a good think, but after she returned from a year in South America, she misses the on-your-feet thinking, creativity and flexibility she could and had to employ to give her patients the care they needed.
I can imagine pulling this off is a great source of satisfaction and validation.
Work emergency? Awesome, I'm fine—great, even. Serious family problem that could be of the life-or-death sort? I will get. Shit. Done. As long as shit needs to be done, and will keep it together the whole time without a moment's lapse or even really having to try not to fall apart.
I sometimes think I'd probably have been an awesome mammoth hunter.
Alas, normal life these days rarely offers opportunities to operate at actual-peak perfect-flow state like that, and I like life enough that I've not tried to fill that void with extreme sports or anything of that sort.
I think the "I actually kind of prefer serious emergencies to normal, safe life, maybe?" thing isn't super rare. Dunno if it's normal, exactly, but I think it's common enough.
The patient, on the other hand, dies after “attempting all the standard procedures” and nobody is at fault.
Cyanoacrylate is just (a very - the most? - common form of) superglue, but the medical formulations were tweaked to be less harmful to skin among other benefits.
There is also VetBond, which is similarly n-Butyl cyanoacrylate as are some medical-grade superglues, but it is only approved for animal use and thus available without a prescription (despite being chemically identical to somemedically approved glues).
[1] https://en.wikipedia.org/wiki/Cyanoacrylate#Medical_and_vete...
US Combat Medics used it in the field in Vietnam in the '70s.
> It emerged that she had not merely fallen from a bicycle but had been flung to the ground while riding on a motorcycle that collided with a car
> Wallace suspected she had previously concealed the extent of her injuries so as to avoid being taken off the flight.
Taking medical history is very hard. Patients minimizing their symptoms or omitting details are just one of many things doctors have to deal with on a daily basis.
I remember from EMT school the informal advice that spontaneous pneumo is a predisposition for certain body types and something as trivial as a burp or hiccups can cause. Tall and thin body type. But this is anecdotal- is there an underlying cause in your case?
Some medics said exactly this for me. This body type is called "franzino" in Brazil and is exactly how I was as a teenager. Strangely my pneumathoraces were not on the same side. On the left side it happened twice which was fixed with two clamps and a pleurodesis. On the right side it occurred only once but considering my predisposition, there's no reason to think it will never happen again.
Imagine walking around knowing your lungs could pop for essentially no good reason, at any moment.
Sure… But a hole in one’s chest isn’t exactly topical, right?
But what do I know? Can lidocaine be injected… sub… topically?
And the broken arm depends on the type of break. I split my humorous bone length ways. Initially because of adrenaline, it was absolutely painless, after an hour the pain kicked in. If I didn't move my arm it was fine but if I moved it, wow, 2nd most painful experience in my life.
Yeah it's interesting how this works.
I once broke my collar bone (I tried jumping up a curb on my bike, the handle bars fell off and I went collar bone first into the edge of the curb). I ended up carrying my bike home in pieces for half a mile and remember it not being too bad. As long as I kept my arm at my side it didn't feel any different than normal but when I lifted up my arm it was one of the sharpest pains I've ever experienced. I only ended up having a hairline fracture too.
As someone who watches bike racing, it is often immediately apparent when someone has broken their collarbone by the way they keep their arm.
So you're hilarious, now that you have an extra funny bone?
They did use a good belt of ("5 star") brandy, but for equipment sterilisation rather than pain control.
As the senior doctor, Wallace was certainly responsible for the care of the patient, which makes his inadequate examination of the patient while still on the ground, and his failure to recommend the patient be sent to the ER for a full examination a little concerning. If true, advising the plane NOT to divert and land because it might make the pneumothorax worse is also strange - as I understand it, you would expect the gas in a pneumothorax to get smaller as the pressure in the cabin returned to (sea level) atmospheric pressure, unless Boyles Law no longer applies? :) [Edited to clarify "atmospheric pressure" means sea level pressure in this case]
I'm just stunned they would still take off with a clearly injured passenger. And then not turn around after an hour into the flight!? They didn't want to land in India, but Hong Kong was only an hour away?
CONTENT OF EMERGENCY MEDICAL KITS
(a) Emergency medical kits should be equipped with appropriate and sufficient medications and instrumentation. However, these kits should be supplemented by the operator according to the characteristics of the operation (scope of operation, flight duration, number and demographics of passengers, number of decks, etc.).
(b) The following should be included in the emergency medical kit:
(1) Equipment
(i) sphygmomanometer — electronic recommended;
(ii) stethoscope;
(iii) syringes and needles;
(iv) intravenous cannulae (a sufficient supply of intravenous cannulae should be available, subject to the amount of intravenous fluids carried on board);
(v) oropharyngeal airways (three sizes);
(v) tourniquet;
(vi) disposable gloves;
(vii) needle disposal box;
(viii) one or more urinary catheter(s), appropriate for either sex, and anaesthetic gel;
(ix) aspirator;
(x) blood glucose testing equipment;
(xi) scalpel.;
(xii) pulse oximeter; and
(xiii) pneumothorax set.
(2) Instructions: the instructions should contain a list of contents (medications in trade
names and generic names) in at least two languages (English and one other). This should
include information on the effects and side effects of medications carried. There should also be basic instructions for use of the medications in the kit and guidance for conversion
of units for the blood glucose test. The operator should make the instructions readily available. If an electronic format is available, then all instructions should be kept on the same device. If a paper format is used, then the instructions should be kept in the same
kit with the applicable equipment and medication.
(3) Medications
(i) coronary vasodilator e.g. glyceriltrinitrate-oral;
(ii) antispasmodic;
(iii) epinephrine/adrenaline 1:1 000;
(iv) adrenocorticoid;
(v) major analgesic;
(vi) diuretic — injectable;
(vii) antihistamine — oral and injectable (including paediatric form);
(viii) sedative/anticonvulsant — oral plus injectable and/or rectal sedative;
(ix) medication for hypoglycaemia (e.g. hypertonic glucose);
(x) antiemetic — injectable;
(xi) antibiotic — injectable form — Ceftriaxone or Cefotaxime;
(xii) bronchial dilator — inhaled (disposable collapsible spacer);
(xiii) IV fluids in appropriate quantity e.g. sodium chloride 0.9 % (minimum 250 ml); and
(xiv) acetylsalicylic acid — oral — for coronary use.
"the doctors successfully released the trapped air from the patient's chest, and she spent the rest of the flight uneventfully eating and watching in-flight movies"
> They sterilised their equipment in cognac
Is there a % alcohol requirement for using spirits to sterilize equipment?
[1] - https://blacktailnyc.com/wh at-is-the-abv-of-cognac/
[2] - https://www.marthastewart.com/7796118/isopropyl-alcohol-perc...
(70% in the maximum strength passengers are allowed to take, anything stronger is considered a flammable liquid.)
Weird to think about surviving something because you were stabbed in the right spot.
Cool stuff.