[HN Gopher] In-flight surgery with a coat-hanger and silverware
___________________________________________________________________
In-flight surgery with a coat-hanger and silverware
Author : minding
Score : 611 points
Date : 2022-03-17 09:23 UTC (13 hours ago)
(HTM) web link (en.wikipedia.org)
(TXT) w3m dump (en.wikipedia.org)
| adenozine wrote:
| I've seen this in a rom-com before, where they poke a hole in the
| person's chest and they survive by decompressing the trapped
| fluids out of the hole.
|
| Weird to think about surviving something because you were stabbed
| in the right spot.
|
| Cool stuff.
| NittLion78 wrote:
| Mark Wahlberg's character in _Three Kings_ has to do this after
| getting shot while wearing kevlar because his lung collapsed.
| selimthegrim wrote:
| I believe there is a rather gruesome in situ depiction of the
| pnuemothorax
| david_draco wrote:
| Now I am curious about improvised in-air operations that were not
| successful?
| johnhenry wrote:
| Does Dr. Wong have a Wikipedia page?
| ChicagoBoy11 wrote:
| I'm surprised by the point about pressurization... cabins do
| depressurize on ascent, but... marginally. Would a difference in
| a few thousand feet atmospheric pressure, equalized SLOWLY,
| really have been that big an issue?!
| phkahler wrote:
| IIRC planes are pressurized to 6000' equivalent, and a quick
| Googling show that to be 11.7psi or about a 3 psi drop vs
| ground level. Also, changes of much less than that can cause
| discomfort in your ears if not equalized. I have no idea what
| 3psi does to the lungs, but with all the discussion about
| ventilators from 2020 I'd say that's a LOT of pressure on them.
| skeyo wrote:
| I somehow read the last sentence of the second paragraph as "and
| she spent the rest of her life uneventfully eating and watching
| in-flight movies" and was very confused.
| gzer0 wrote:
| Interestingly, the surgeon published a post-mortem case report
| titled "Managing in Flight Emergencies" in the _British Medical
| Journal_ [1].
|
| The title of the publication makes it seem as if this in-flight
| surgery with a coat-hanger is a routine occurrence. Remarkable!
|
| [1] https://www.bmj.com/content/311/7001/374
| tsm wrote:
| > The patient was now comfortable, felt well and we retired to
| our seats to recover. Eight hours later I was again summoned by
| the stewardess to see the patient, who had developed more chest
| pain and dyspnoea.
|
| > 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.
| lupire wrote:
| > underwater seal drain
|
| 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.
| dmurray wrote:
| Eight hours! It's hard to believe the woman's condition was
| critical enough to require invasive surgery with these
| makeshift tools mid-flight, but so stable post-op that the
| doctors did not recommend an emergency landing. I understand
| they recommended against landing pre-op because of worries
| about cabin pressure, but why not after the surgery? She's
| going to have to come down at some point.
| mbubb wrote:
| destination was Delhi - mmaybe no good medical option en
| route?
| classichasclass wrote:
| Having been the "is there a doctor on board" doctor before:
| you make the call based on what's in front of you and the
| turmoil that would result from a precipitous landing. The
| case I had to be involved with was a relatively
| uncomplicated chest pain. I couldn't rule out angina, but
| the patient was stable and they had aspirin and it started
| halfway into a 4-hour flight. The patient remained stable
| all the way through and I released the individual to EMS on
| the other end. I don't see what an early landing would have
| bought in my case, and I'm not sure what it would have
| bought here.
| patrec wrote:
| Why further inconvenience everyone else for this moron, if
| they (clearly correctly) judged her no longer to be in
| danger?
| manquer wrote:
| Expecting decision making to be perfect after an accident
| like that is ridiculous. Bike perfectly valid and
| commonly used word for motorcycle in many parts of the
| world.
|
| 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.
| gambiting wrote:
| I really hope that doctors don't provide medical advice
| based on idiocy(or lack of) of ones actions. If she had
| to undergo emergency surgery in-flight with a coat
| hanger, I'm really surprised an emergency landing wasn't
| recommended by the doctor. The origin of her injury
| should have had zero bearing on it.
| patrec wrote:
| If only we would leave more of these decisions to arm-
| chair bien-pensants, second guessing two seemingly highly
| competent medical professionals. I am sure the woman in
| question would also really have appreciated being settled
| with the likely ruinous debts resulting from a medically
| needless emergency landing.
| gambiting wrote:
| I'm just saying I'm surprised such a decision was made,
| that's all.
| aqme28 wrote:
| I don't understand your point. If it's no longer an
| emergency, why require an emergency landing?
| refurb wrote:
| When you just did surgery with a knife and fork seems
| like an urgent enough situation to land?
| aqme28 wrote:
| If there are two doctors there saying that the situation
| is not urgent, then who am I to disagree with them?
| mcv wrote:
| Maybe not if the surgery was successful. As long as the
| condition is stable, it might not matter where they land.
| Might as well land close to wherever she needs to be,
| instead of in a completely different country.
| refurb wrote:
| How is surgery "successful" when they used a coat hanger?
| Can you imagine the infection risk?
|
| And sure, fly another 1-2 hr to get to the final
| destination, but they flew 8+ hours.
|
| It kinda makes no sense.
| whoisburbansky wrote:
| They mention in passing that cognac was used to disinfect
| things. Not foolproof, but not exactly a sepsis inducing
| nightmare either.
| refurb wrote:
| Cognac is usually what? 30-40% alcohol?
|
| It needs to be 70%.
|
| https://www.cdc.gov/infectioncontrol/guidelines/disinfect
| ion...
| cjrp wrote:
| The one upside from COVID; no flight will be short of
| hand gel to sanitise with! Actually, is hand gel even
| good for that?
| ls612 wrote:
| It's literally designed to kill bacteria. Funnily enough
| it does next to nothing against respiratory pathogens
| like covid which spread through the air not through
| surfaces.
| pmyteh wrote:
| Those guidelines recommend 60-95% ABV (and note that
| effectiveness drops off sharply below 50%) but also
| report that at least some pathogens are killed in seconds
| with exposure to 40% ethanol.
|
| If all you have to disinfect your ad hoc instruments is
| brandy, then use it: way better than nothing.
| toyg wrote:
| _> Can you imagine the infection risk?_
|
| 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.
| aqme28 wrote:
| I would define a surgery's success by the success of the
| outcome, not by the tools that go into it. How would you
| define a "successful" surgery?
|
| 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.
| matheusmoreira wrote:
| Not indefinitely. The point of all emergency medical
| treatment is to stabilize the patient before they get to
| a proper hospital.
| aaaaaaaaata wrote:
| Liability is a bitch, and ruins society.
| matheusmoreira wrote:
| The patient was stabilized but the risk of complications
| still exist. In such an event, it's always better to be
| in fully equipped and staffed hospital. The only reason
| not to land the plane is if it is literally impossible to
| do so.
| Maken wrote:
| Maybe she didn't have any kind of health insurance in any
| country except the one she was traveling to. So when the
| doctors told her she could endure the rest of the flight,
| she chose to do so instead of going bankrupt by the medical
| fees. It would be also insteresting to know if she hid her
| injuries before boarding for the same reason.
| refurb wrote:
| It's not her decision, it's the pilot's decision to
| divert or not.
| kube-system wrote:
| The pilot would make that decision based on a third party
| assessment of the situation relayed to them.
| ada1981 wrote:
| Doubtful. Do people go bankrupt by medical debt in other
| countries? Seems unlikely to get judgment and collect.
| kube-system wrote:
| I think it's simply unlikely because debt is always
| preferable to a life threatening emergency.
|
| That being said, from a global perspective, "bankruptcy"
| is not a good measure of economic burden. There are worse
| debt outcomes than bankruptcy.
| sgjohnson wrote:
| Bankruptcy is actually quite a piece of cake in several
| US states. In fact most of them even let you keep your
| home.
|
| 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.
| kube-system wrote:
| That's what I was alluding to. Part of the high
| bankruptcy rates in the US are because we have very
| liberal laws about bankruptcy.
|
| 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.
| manquer wrote:
| Delhi was the nearest airport , India has[1] one of the
| cheapest healthcare in the world which is considered
| acceptable.
|
| 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
| FabHK wrote:
| I wager to say that to most people in the developed world
| such thoughts would not occur, and almost certainly not
| to Brits (that are used to the NHS).
| sgjohnson wrote:
| The NHS is garbage. After experiencing them once I took
| on a private health insurance that cost me PS300ish per
| month.
|
| 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 PS300 a month on
| health insurance so they just cope with the NHS.
| FabHK wrote:
| Yes, mate, you might complain about the NHS and you might
| wait and you might curse it, but you'd not entertain the
| idea of going bankrupt because you needed medical care.
| ViViDboarder wrote:
| Wow, only PS300? Private insurance in the US is so much
| more than that. When you get care, is a portion paid by
| NHS and the remainder from the private company? Or maybe
| the existence of NHS puts healthcare costs much less than
| that in the US.
| sgjohnson wrote:
| > When you get care, is a portion paid by NHS and the
| remainder from the private company?
|
| 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).
| teetertater wrote:
| Imagine if publication titles started being clickbait:
|
| "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.
| JackFr wrote:
| > Interestingly, the surgeon published a post-mortem case
| report titled "Managing in Flight Emergencies"
|
| Literally NOT a post mortem
| mikkohypponen wrote:
| Full content can be read via researchgate:
| https://www.researchgate.net/profile/W-Angus-Wallace/publica...
| iso1210 wrote:
| This line got me:
|
| "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"
| matt_s wrote:
| For me it was:
|
| > They sterilised their equipment in cognac
|
| Is there a % alcohol requirement for using spirits to sterilize
| equipment?
| MPSimmons wrote:
| eau de vie has an ABV of 72%, according to [1]. That's high
| enough to kill coronavirus, according to [2]
|
| [1] - https://blacktailnyc.com/wh at-is-the-abv-of-cognac/
|
| [2] - https://www.marthastewart.com/7796118/isopropyl-
| alcohol-perc...
| Symbiote wrote:
| It says it was cognac, which is typically around 40%. That
| was probably the strongest alcoholic drink on the plane.
|
| (70% in the maximum strength passengers are allowed to
| take, anything stronger is considered a flammable liquid.)
| Animats wrote:
| Lufthansa takes this seriously. They encourage doctors to sign up
| for an incentive program, and about 10,000 doctors who fly
| Lufthansa have signed up.[1] They carry an emergency kit for use
| by a doctor on board, one that goes much further than a first aid
| kit. The airline covers medical liability.
|
| [1] https://www.lufthansa.com/us/en/doctor-on-board
| matheusmoreira wrote:
| > She stated she had fallen from a "bike", by which Wallace
| assumed she meant a bicycle.
|
| > 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.
| HNHatesUsers wrote:
| fundad wrote:
| Oh he was a trained surgeon. Meh. LMK when the most experienced
| nearby medic is a meat-packer.
| sgsvnk wrote:
| Stories like these reminds me how a lot of talent is going waste
| trying to improve CTR on Ads and other futile jobs.
| et2o wrote:
| I'm not sure those people would make great surgeons or
| physicians as a rule. I don't think lack of talent or
| intellectual horsepower in medicine is an issue at all.
| amatecha wrote:
| Yeah, but even if they don't take jobs as surgeons or
| physicians, basically literally any other job would have more
| net benefit to society :)
| ghufran_syed wrote:
| The funny thing is, as an orthopedic surgeon in England, Wallace
| probably hadn't put in a chest tube in years, while the other
| "junior" doctor training in internal medicine, Tom Wong, probably
| did one every week. I have no inside knowledge, but I suspect Dr
| Wong probably did most of the procedure while the senior doctor
| Wallace took most of the credit later.
|
| 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]
| [deleted]
| kayodelycaon wrote:
| My first flight on a plane also happened to had a passenger
| have a medical problem. She had passed out briefly. The pilots
| had that plane turned around _fast_ and paramedics were waiting
| at the gate.
|
| 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?
| bouncycastle wrote:
| That makes sense. Once I took a packet of Doritos on board, and
| it blew up like a balloon once the plane took off and went to
| cruising altitude!
| s0rce wrote:
| I live at about 5000ft and all our packages are extra poufy.
| It amuses me every time I go to the store.
| [deleted]
| abortionlover69 wrote:
| conradev wrote:
| The typical way to handle a pneumothorax (without an existing
| hole in the chest) in pre-hospital care is with a chest
| decompression needle, which is often a part of a paramedic's kit:
|
| 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...
| robbiep wrote:
| Thats the typical way to handle a tension pneumo, which is
| slightly different but highly emergent. It's unlikely the case
| described was a tension pneumo because of the time period, but
| it very well could have developed that way, and regardless the
| treatment should be as useful - however one of the benefits of
| a needle decompression is that, because the lung has compressed
| so significantly, you don't have to be too concerned about
| where you drop it (ie you will always hit an airspace). whereas
| in the intermediate stages (which is what it sounds like they
| were treating), entering laterally ~4/5th intercostal space is
| better because you're less likely to hit lung which still
| occupies a significant percentage of the chest cavity - ie more
| likely to hit the air pocket AND provide definitive treatment
| (which clearly some macgyver surgery is not).
|
| 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
| rkachowski wrote:
| How much of a factor is the (relatively) super low air
| pressure in an airplane at cruising altitude? Does this cause
| more or less severity wrt the amount of air trapped in the
| chest?
| KineticLensman wrote:
| >> _Wallace did not deem a landing at the nearest airport
| in Delhi to be viable either, because the increase in air
| pressure during descent could also kill his patient, and
| thus the only option was to perform an immediate surgery_
| rkachowski wrote:
| That does not talk about the complications of the air
| pressure environment on the surgery itself.
| robbiep wrote:
| So i'm not an anaesthetist and therefore I claim no high
| ground with regard to this rusty attempt at respiratory and
| gas physiology -
|
| 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
| epmaybe wrote:
| How I imagine you:
|
| _cracks knuckles_
|
| "time to open up west's respiratory physiology again"
| robbiep wrote:
| That's pretty damn funny. Seriously that textbook is
| amazing
| JshWright wrote:
| The anterior axillary site is increasingly common for needle
| decompression as well. For the reason you mentioned, as well
| as the fact that it is a shorter distance (a common failure
| node for needle decompressions is the needle failing to reach
| the pleura).
| Traubenfuchs wrote:
| ,,emergent" means the prevalence is increasing? Why?
| gumby wrote:
| From your name and punctuation I assume you're German.
|
| 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"
| ramses0 wrote:
| Agreed:
|
| 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".
| robbiep wrote:
| I've never thought of it as slang but rather a
| descriptive term for patient condition but you're bang on
| [deleted]
| neilduncan wrote:
| Haha! My grandfather was an orthopaedic surgeon in Edinburgh, and
| a friend of Mr Wallace...
| mikotodomo wrote:
| This is very cool. I like this place because it has threads like
| this you wouldn't usually find. Today, this guy would probably go
| to jail or let the person die because it's less legally
| complicated.
| marcodiego wrote:
| I've had an spontaneous pneumothorax when I was a teenager. Had
| to undergo emergency surgery with only local anesthesia. The
| surgeon while cutting my chest asked: "You're sure it is this
| side, right?", which I confirmed. He then said: "Ok, if you're
| wrong I'm not going to jail alone."
| vocram wrote:
| While the surgeon was pointing to the left side of OP, they
| just answered "it's the right side" meaning that the right side
| was the right side ... Guess what the surgeon did.
| taneq wrote:
| This is why I say "correct" instead of saying "right."
| hammock wrote:
| Doesn't help if the doctor's question was "Am I cutting
| into the right side?"
| saary wrote:
| When I've practiced as a paramedic the best practice was
| to ask the patient to point to the pain and not just
| verbally confirm
| lostlogin wrote:
| Two confusing ones I hear are:
|
| "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".
| sjmm1989 wrote:
| This is probably the smartest move. When I am dealing
| with someone who doesn't seem to understand what I am
| saying due to language barrier, I start dealing with
| physical communication instead however possible. It can
| look odd, and be sort of funny to witness; but it works a
| charm more often than not. There are just some things we
| all generally understand once the body becomes involved.
| marcodiego wrote:
| English... what a language! The right side was actually the
| left side. Fortunately the talk was in Portuguese.
| digisign wrote:
| direito has the same issue in Portuguese, does it not?
| marcodiego wrote:
| The word "direito" in Portuguese can mean many things:
| "not broken", "right of law", "discipline of law" and
| "right side". When you're talking about sides or
| direction it is clear what meaning it has. Mixing the
| meaning of the word "direito" in Portuguese is very very
| rare.
| marcosdumay wrote:
| Not exactly. "E o lado direito" is unambiguous, as the
| meaning of "correct" can not be used on this context.
| mikeryan wrote:
| About three years ago I got in a mountain bike crash and broke
| my collar bone and three ribs, managed to ride off the mountain
| (for any locals it was the Mailboxes trail in Santa Cruz) drove
| home to the East Bay and walked into the ER.
|
| 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.
| iso1210 wrote:
| I did some hostile environment training a while back, one of
| the medical courses was about "sucking chest wounds", where
| someone gets shot (or stabbed), and the action of breathing
| fills the chest cavity and thus means the lung can't work.
|
| 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).
| mbubb wrote:
| The civilian version of this class us called TECC (in the US)
| i took it last october- quite good. It is an adaptation of
| the military TCCC "combat casualty" class. Thus class was
| specifically for EMTs and Paramedics but there us a more
| general class called "stop the bleed" intended fir more
| general audience. I think everyone should take a cpr/bls
| class and stop the bleed if they can. Good skills!
| mbubb wrote:
| so funny you mention the vaseline impregnated gauze. I have
| had more than one instructor say the best thing to use as a
| chest seal is the wrapper itself. Vaseline sucks to try and
| tape down. The metallic shiny wrapper it comes in makes a
| nice seal though.
| geophile wrote:
| Like a few people here, I also had spontaneous pneumothorax as
| a teenager, a few times. Never severe, no medical intervention
| required (beyond diagnosis), which I'm finding a bit strange,
| based on what others here are writing. This was in 1975, so
| maybe procedures are different now?
|
| 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.
| sfe22 wrote:
| How did you get it. Was it a major accident?
| marcodiego wrote:
| Spontaneously! My lung simply ruptured. I was lying in my bed
| when it happened the first time.
| praptak wrote:
| Wait, there were more times it happened to you?
| marcodiego wrote:
| See my other comment:
| https://news.ycombinator.com/item?id=30710381
|
| 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.
| mrtranscendence wrote:
| If you get one you're more likely to have other
| incidents, unfortunately.
| epmaybe wrote:
| No, these things just happen for a variety of reasons.
| Smoking/vaping puts you at higher risk. There's probably
| other risk factors too.
| bocytron wrote:
| Yeah, if you're tall and thin as well.
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2950234/
| Ovah wrote:
| The most common category is "primary spontaneous".
| Predominantly young (85% <40yo), healthy males (6 times
| more common). Smoking contributes, and I believe being tall
| and skinny does so as well.
| jacobmartin wrote:
| Short and fat--never a smoker. Still collapsed my right
| one and then the left one a week later. The doctors said
| they'd never seen that (bilateral in such a short
| timespan with no apparent cause) and had no idea what
| could be causing it. I had to laugh. Pectoris Excavatus
| or other skeletal abnormalities can cause it but I don't
| have any of those either. Just luck of the draw I guess.
| jtbayly wrote:
| It's a funny quote, but I'm really not sure what the doctor
| meant...
| lupire wrote:
| He was joking about how the patient shared responsibility for
| his surgical plan
| fritzo wrote:
| But who would accompany him to jail, a cadaver?
| busyant wrote:
| When you dissect a joke, it dies on the operating table.
| kps wrote:
| Things are dissected when they're already dead. When you
| _vivisect_ a joke, it dies on the operating table.
|
| Oh. Never mind.
| amatecha wrote:
| hahaha! I laughed way too hard at this :)
| [deleted]
| ISL wrote:
| The patient wouldn't die, but the surgeon would have
| punched a hole in the abdominal cavity on the wrong side.
| That would create a new wound, but wouldn't fix the
| initial life-threatening problem. So then, he'd have to
| punch a hole on the correct side, fixing the problem.
|
| After that, the surgeon would have to contend with
| malpractice concerns while the patient healed from two
| holes in their chest, one unnecessary.
| IfOnlyYouKnew wrote:
| Malpractice, of course, is civil law. Nobody going to
| jail.
| JoeAltmaier wrote:
| There's a 'Good Samaritan' law in most states, protecting
| those that try to help in an emergency in good faith.
| et2o wrote:
| Doesn't apply to a wrong-sided procedure
| JoeAltmaier wrote:
| That's incorrect
| xenophonf wrote:
| That's the joke.
| philliphaydon wrote:
| Was it the right side... I feel like the story ended too
| quickly other than you survived to write this...
| knicholes wrote:
| It sounds like the surgeon believed that if being misled, op
| would also be joining the surgeon in jail. Perhaps the wrong
| side was chosen and the surgeon moved to the other side to
| finish what was originally intended.
| kmano8 wrote:
| This happened to me in college. Driving home from the movies,
| chest started to hurt on inhale .. I decided to "sleep it off",
| which obviously didn't work. Went to the ER in the morning. Got
| the chest tube and spent about a week seeing if it would heal
| naturally, then they removed the offending part of my lung, and
| did a mechanical pleurodesis (a procedure that sticks your lung
| to the chest wall so it can't collapse). All-in, was over two
| weeks in the hospital, and a good bit of recovery after.
|
| I fit the 5'9", young, male, otherwise healthy group described
| here.
| yowlingcat wrote:
| Goodness, is this more common than it seems? Happened to me
| in my mid twenties, same build. I remember talking to the doc
| (thank goodness it went away with oxygen for a few days) who
| said "Yup, this stuff just happens to otherwise healthy males
| your age. No one's really sure why."
|
| Was a little unsettling.
| vlovich123 wrote:
| I'd think you were my good friend in college except the
| height is wrong. Didn't realize this was so common.
| throwaway684936 wrote:
| I had those kind of pains for years and they were always
| minor and went away after a few days. Always wondered what
| they were, but figured they were harmless. Eventually I got a
| worse one, went to the hospital, got a chest tube. It went
| away but I got another bad one, so they did surgery. A couple
| months later the same process happened to the other side.
|
| 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.
| sizzle wrote:
| Hope you're doing better now. That is a lot to go through at
| a young age to say the least.
| LordDragonfang wrote:
| For anyone reading these comments with growing anxiety who
| gets _occasional, short duration_ stabbing pains when
| breathing in (lasting only a couple minutes at most), allow
| me to put your mind at ease by directing you to the Wikipedia
| page for precordial catch syndrome:
|
| 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)
| sjmm1989 wrote:
| I've gotten similar for a long time while growing up. Still
| get this now and then on my left side. Always my left side.
|
| 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.
| marcodiego wrote:
| Beware that even a spontaneous primary pneumothrax can turn
| into a tension pneumothrax, a condition when a natural one-
| way valve forms and continuously increases pressure inside
| the chest eventually compressing heart and arteries.
|
| Even a spontaneous primary pneumothrax must be handled
| seriously. It can become life threatening.
| davidw wrote:
| Had the same experience, at about 21, although I think they
| didn't cut anything out, just stapled around the hole in the
| lung. I was skinny and in good shape.
| pmarreck wrote:
| Yet another reminder that human bodies are incredibly fragile
| omegant wrote:
| The European rules for emergency medical kit (I guess FAA rules
| are very similar) also automatic defibrilators are increasingly
| being included in these kits:
|
| 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.
| mbubb wrote:
| expected an AED - wonder if inflight vibration makes it
| unusable
| thomasjudge wrote:
| In the US all commercial airlines are required to carry AEDs
| and train staff to use them. So the internet tells me
| mbubb wrote:
| NJ EMT here and the guidance we are given is to not run AED
| while driving as the vibrations can make the analyzer
| misread. There are probably different types of AEDs to
| account for this
| et2o wrote:
| I'm guessing the tradeoff in the air is worth it. Can't
| stop to run an AED and if they need a shock it's because
| they're in a potentially fatal rhythym
| umanwizard wrote:
| There also isn't constant vibration while flying (except
| during turbulence) like there is while driving.
| quinncom wrote:
| What emergency would necessitate a urinary catheter?
| kayodelycaon wrote:
| Enlarged prostate blocking the flow of urine for one example.
| My grandfather couldn't relieve himself without a catheter
| during the last year of his life.
| brnt wrote:
| There's hacking and there is _hacking_.
|
| 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.
| [deleted]
| worewood wrote:
| Yeah, but as a South American, one thing is being able to be
| creative, another is _needing_ to be creative, which means
| doctors are not being given the resources they need (which is
| common here).
| toyg wrote:
| Letting doctors have fun under pressure, or ensuring good
| outcomes for patients? Mmmh, I wonder what we should choose
| as a society... /s
| virchau13 wrote:
| Yeah, but the problem is that some doctors are not capable of
| doing things of this sort safely, and thus doctor regulations
| happen. There are definitely unnecessary regulations out there,
| but I imagine that most of them are simply yet another symptom
| of "any large enough system eventually gets ruined by abuse".
| brimble wrote:
| I'm naturally cool as hell when something goes wrong. Dunno
| why, just am (I'm definitely _not_ especially cold-blooded in
| general). Weird thing happens in traffic? I act, get out the
| other side, and only in retrospect go "oh, wait... that was
| really bad" (now, oddly, if something happens ahead in traffic
| but _doesn 't_ affect me, after a beat I often get a pretty
| strong adrenaline kick that's fairly unpleasant, but for
| whatever reason it either doesn't happen or I never feel it at
| all if I actually need to react)
|
| 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.
| marcodiego wrote:
| Famous case in Brazil: in 1998 a surgeon used cyanoacrylate
| glue on the heart of a patient:
| https://www1.folha.uol.com.br/fol/geral/gx055168.htm
| et2o wrote:
| Using cyanoacrylate glue is is very common in medicine for
| skin closure. Doesn't seem ridiculous to use in other
| settings.
| ricardobeat wrote:
| The point is that most surgeons today would not pull that
| off, as if it goes wrong their career might end abruptly.
|
| The patient, on the other hand, dies after "attempting all
| the standard procedures" and nobody is at fault.
| matheusmoreira wrote:
| Cyanoacrylate also bonds with proteins. It's a commonly used
| topical hemostatic and adhesive. It's usually for relatively
| dry and clean skin incisions but I certainly understand their
| attempt to use it in open surgery if things got desperate
| enough.
| Yajirobe wrote:
| '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'
| nomilk wrote:
| It's so good it warrants standing applause.
| WalterGR wrote:
| How does one do that after having a hole cut in one's chest?
| Pain-wise.
| marcodiego wrote:
| The hole had lidocaine, a relatively good topic anesthetic.
| If don't move too much, the tube inside the chest doesn't
| causes too much pain. Actually, once the tube is inserted the
| feeling of relief and been able to breath normally is quite
| good. Disclaimer: I've had 3 spontaneous pneumathoraces.
| mbubb wrote:
| > 3 spontaneous pneumathoraces...
|
| 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?
| marcodiego wrote:
| > spontaneous pneumo is a predisposition for certain body
| types
|
| 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.
| gavinray wrote:
| Jesus christ mate, human biology is fucked.
|
| Imagine walking around knowing your lungs could pop for
| essentially no good reason, at any moment.
| robbiep wrote:
| It's not comfortable (pleural rubbing of catheter) but
| analgesia requirements for a chest tube post insertion are
| pretty minimal
| chimprich wrote:
| Presumably the patient had quite a high pain threshold, since
| she was already ignoring a broken arm and ribs in addition to
| the pneumothorax in order to make her flight.
| philliphaydon wrote:
| There isn't much you can do about broken ribs afaik?
|
| 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.
| nickjj wrote:
| > 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.
| eCa wrote:
| > As long as I kept my arm at my side it didn't feel any
| different
|
| As someone who watches bike racing, it is often
| immediately apparent when someone has broken their
| collarbone by the way they keep their arm.
| bbarnett wrote:
| A guess, but a good belt of whisky, some asprin, and
| happiness at not being dead?
| toyg wrote:
| Adrenaline is a hell of a drug.
| pmyteh wrote:
| The BMJ report states that the onboard medical kit had
| local anaesthetic available (though it also states that "in
| the heat of the moment, neither I nor Dr Wong were able to
| calculate the percentage of lignocaine in it" and isn't
| entirely clear about whether they used it anyway or went in
| without).
|
| They did use a good belt of ("5 star") brandy, but for
| equipment sterilisation rather than pain control.
| adastra22 wrote:
| I'm not sure which one was more badass, the surgeon or the
| patient.
| rwmj wrote:
| I raise you the guy who removed his _own_ appendix in the jungle
| after escaping from a prisoner of war camp:
| https://www.smh.com.au/culture/books/the-war-hero-who-remove...
| sva_ wrote:
| Or this Russian guy on an expedition in the Antarctic
|
| https://en.m.wikipedia.org/wiki/Leonid_Rogozov#Antarctic_ser...
| darekkay wrote:
| Similar to what happened to a doctor in Antarctica:
| https://www.antarctica.gov.au/about-antarctica/people-in-ant...
| wadkar wrote:
| All of these incidents remind me of episodes from House MD. I
| swear they made one on this Antartica where House did a "zoom
| call".
|
| The airplane guy had more complications than ruptured lung
| but apparently he had just came out of scuba diving into the
| plane.
| alasdair_ wrote:
| I know a guy who went there (McMurdo in Antartica) the year
| after this happened (so similar situation - there is only one
| doctor that needs to do everything for everyone). Again,
| you're there for a _long_ time and there is no help coming if
| you have a problem in the middle of winter.
|
| 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!"
| Johnny555 wrote:
| _that they strongly suggest you get your wisdom teeth taken
| out. The guy I know did so a few weeks before leaving._
|
| 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.
| buu700 wrote:
| That was my reaction as well. I've had 75% of my wisdom
| teeth in for a decade+ with no issues. Seems odd to make
| any major medical decision so arbitrarily.
| dclowd9901 wrote:
| Having had an infected tooth and impacted molars, I can
| safely say I would gleefully smash my own jaw with a 3 lb
| sledge to stop the kind of pain that tooth problems cause,
| so even a doctor with very limited experience would be
| exponentially better.
| ssully wrote:
| You know, in normal circumstances that quote would be
| terrifying but I think I would have some minor relief if my
| only option for my issue has at least some experience!
| jonjon10002 wrote:
| NASA first addressed this during the Skylab training. They
| sent two of each crew to a 14-day crash course at an Air
| Force dental clinic, where they took volunteers and started
| pulling teeth from patients.
|
| More info: https://books.google.com/books?id=sR5Cm_zeIekC&l
| pg=PA84&ots=...
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