CHCS Perspectives Summer/Fall 2013

PERSPECTIVES • SUMMER-FALL 2013 – Page 38 On a red-eye flight from Sacramento to Orlando, I relax and begin to contemplate all that awaits my family and me in Orlando. I have just accepted a faculty position at my alma mater, Nova Southeastern University. My girls are seated with me and drift off to sleep quickly. I must have done the same because I am startled when I am awakened. “Are you ready?” a flight attendant asked. “I have a passenger up front having a seizure.” I unbuckled my seatbelt and let my girls’ heads fall onto the seat. Making my way to the front of the plane, I encountered a middle-aged female buckled into her seat next to her husband. She clearly showed signs of tonic-clonic seizure— semiconscious with muscle rigidity, facial contortion, and convul- sions of her upper body. I quickly introduced myself to her husband. “Sir, my name is Laura McClary, and I am a physician assistant that will be taking care of your wife this evening. I need you to stay calm and try to answer some questions for me.” The patient was immediately moved to the aisle and her med- ical history assessed through her husband. She did not have her list of medications with her and had no known allergies. Next, her airway, breathing, and circulation were assessed. She was slightly bradycardic, with a heart rate of 56. The automated external de- fibrillator (AED) and emergency bag were then handed to me by a flight attendant. The patient’s history included only the consumption of one al- coholic beverage four hours prior to the flight and no new medica- tions or doses. Her husband stated she was in good health but had medical problems. She was not a smoker and had no recent surgery. After the patient was deemed to have a stable airway and normal respirations, the AED was applied to her chest. She had a normal sinus rhythm with a heart rate of 62, so no shock was advised and the AED was left on the patient to monitor her rhythm. Her phys- ical exam revealed poor skin turgor and somewhat dry mucous membranes. The patient regained consciousness and quickly be- came less rigid and the convulsions ceased. I decided to treat her for shock and stroke at this time. I elevated the patient’s feet by stacking other passengers’ carry-on luggage in the aisle. I also crushed a 325 mg aspirin and gave to her orally, followed by nitro- glycerin sublingual. She continued to deny any pain, nausea, headache, vision changes, or hearing loss, and her pupils were equal, round, and re- sponsive to light. She was able to answer questions by shaking her head, and I was able to administer 3 L of oxygen via face mask to the patient. She did not exhibit bowel or bladder incontinence and her strength and ROM were equal in upper and lower extremities with no facial paralysis. However, she did slightly slur her words and exhibited a variable respiration rate ranging between 12-18 per minute. Her heart rate also fluctuated between 52-62 beats per minute. I also observed that her lateral eyebrows were missing and asked her husband as to whether she was hypothyroid. He stated that she was and took a low dose of Synthroid every day but had continued to have symp- toms of constipation, weight gain, and cold intolerance. He again denied any significant medical history and stated his wife was an occupational therapist. We continued to monitor the patient, her vitals, and the AED during flight. There was a terrible thunderstorm when we were above Dallas, so the pilot deferred to my opinion as to whether or not an emergency landing was required at this time. Since the pa- tient was stable, I elected to continue to Atlanta where a paramedic team would meet us at the gate. The patient continued to improve and asked for sips of water for the remainder of the flight. New Faculty Member SAVES THE DAY By Laura Gunder-McClary, D.H.Sc., M.H.E., PA-C, Assistant Professor Physician Assistant Program – Orlando Campus