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Case Presentation: a 53-year-old female passenger in the economy section has become ?unresponsive.?
You are flying from London Heathrow Airport to New York JFK on British Airways when a flight attendant makes a request over the intercom for medical personnel to respond to an ill passenger. Among the responders is a Basic Life Support-trained EMT, a nurse intensivist, a psychiatrist, and yourself, an emergency medicine physician. The flight attendant informs you that a 53-year-old female passenger in the economy section has become ?unresponsive.? Her husband says that she has a history of diabetes, hypertension, and coronary artery disease; has 2 stents; and is currently taking insulin, aspirin, clopidogrel, and metoprolol. On physical exam, she is initially diaphoretic, pale, and lethargic, but quickly regains consciousness and is able to provide some history, and she reports feeling lightheaded prior to losing consciousness. She reports ongoing general weakness and presyncope. She is bradycardic at 35 beats/min but she is alert, with no increased work of breathing. Her neurological exam is nonfocal, and she has a soft abdomen and thready peripheral pulses.
For your diabetic patient with weakness and loss of consciousness, you were able to access the AED and could see that she was bradycardic with a ventricular escape rhythm. Her husband retrieved her glucometer from her carry-on luggage, and her glucose measured at 45 mg/dL. She was able to drink some juice, and her glucose improved to 100 mg/dL and her heart rate improved to 60 beats/min, with improved mental status and peripheral pulses. She reported improving symptoms. The flight attendant connected you to the medical control officer employed by the airline, and you were able to describe the situation to her. Given the patient’s improving condition and the current location over the Atlantic Ocean, she recommended continuing to your final destination. The patient did well for the remainder of the flight, and was transported to an ED by EMS upon landing.
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