- 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)