Airplane Medical Emergency | WE COULDN’T LAND! | Wednesday Checkup

– 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)

100 thoughts on “Airplane Medical Emergency | WE COULDN’T LAND! | Wednesday Checkup

  1. My grandma sat next to someone that died on a plane going to England. The flight attendant put a blanket over the dead lady

  2. I agree with having epipens…
    I’m a RN and I’ve also had to intervene on a flight from Canada to Cuba.
    Ended up giving the lady a Benadryl shot which worked (along with Oxygen and other measures as she had passed out)
    Again, the passengers were happy because we didn’t have to do an Emergency landing in the states and ruined their trip to Cuba, lol.
    I got a free meal and wine from the airline as a thank you. 🙂
    And yes I did get orders from a medical doctor through the pilot to administer the injection.

  3. I bring my epipen everywhere with me. Once I had an anaphylactic shock at 3 am on a trip with my friends. I injected it myself (I was glad I made it before my airways started closing) and then massaged the leg to reduce swelling. I woke up the next day perfectly fine and never went into the hospital. This happened when I was 15.

  4. Srsly?? I’m biting my mouth Edge till it’s bleedin “HOTTEST DOCTER” MAN HES LITERALLY A NERD

  5. I was really hoping for this scenario
    Dr. Mike: This man needs to go to a hospital!"
    Flight attendant: "A hospital? What is it?"

    Dr. Mike: "It's a place where they take care of sick and injured people, but that's not important right now."

  6. I went to Israel and it's on my YouTube channel Adventures of a cowgirl now I'm back in Texas I miss Israel its clean but not only that people are Extremely nice

  7. My dad is in the army, and one time he went out into the field and he came back with his legs completely covered in ticks. This as I’m sure you’ve guessed gave him the allergy dr mike was referring to. However he later had a surgery on his gallbladder that somehow got rid of the allergy.( I don’t really know the logistics of it.)

  8. I live in maryland and my parents called the cdc before they really released any information about it. my mom became allergic to red meat after being bitten. it. was toootally fun.

  9. This was an amazing story with a great ending. Hearing stories like this brightens my day. You are this man's hero and you were there for a reason. And things happen for a reason. Thank god you were there on the same flight as this man. Keep it up Dr. I enjoy watching your videos. I learn a lot from you and knowledge is power.

  10. I'm Egyptian and Egypt and Israel have had tensions between each other for decades, but I'm putting it all aside for Doctor Mike because I respect him and hope to be a neurosurgeon one day.

  11. You were on Fox News, so I don’t believe your story because they’re only good at lying. Also I unsubscribed cuz you went to “Israel” Tel Aviv 😑

  12. I am really shocked that they don't have epipens on board and that flight attendants are trained to use them. My sister is allergic to EVERYTHING. So I got used to my mom always carrying one and she trained me on how to properly use one just in case, Sasha trained her boyfriend on how to use one and always carries one. You would think an airline would do the same.

  13. So I recently just finished binge watching Chicago Med, and in one of the episodes an exact scenario is explained, in which the patient was bitten by a lone star tick, and was undergoing the allergic reactions as describes. The whole point to my comment was that, for once, I find it so strange that I know what a medical professional is talking about and I'm not just sitting here nodding my head pretending to understand loll

  14. “Is there an MD on board?” See MA double positive, and the Dr. Mike wearing a large Jewish Star of David posted around his own throat. Dr. Mike clearly states he has no faith at all. This presumed anaphylactic shock across the Atlantic with the drummer, a presumed stranger, Matt Faraco, occurred right after I showed the letter I signed to Dr. Mike Vershavski in Inquiry about medical ethics to the New York Board of Medical Misconduct for misusing of encoded words with Dilshad Atwall, “you’re a genius”, “erogenous”. Probable logic leads me to believe Dr. Mike is utilizing social media to condescend and to avoid the potential $25000 illegal drug charges for transporting MD MA which have similar reactions in one having Anaphylactic Shock while crossing the Anlantic Ocean without a “t”.Decoding online social media and drug scandals. He used the situation to demonstrate his alpha social category because so many people on that flight and other flights would be subject to loss of license, and potential permanent illegal substance abuse and drug trafficking charges. Dr. Mike provides “zero proof”, “zero video footage from airline from anyone”, “zero second opinion”, and 1 hour of CPR. Read about the adverse reactions to MD and MA double positive.Is it a “fair echo”, I had been communicating to Mikhail since May 2019, during the Christian holiday, “Lent”, in which I sacrificed all social media, and my sex life, except I remained connected to he. Dr. Mike clearly states he was not raised religious. He did nothing with the Jewish Group, instead he rode around on a 4 Wheeler on the Holy Land, to intentional play “Game Of Thrones” with his New York Jewish Senator, Church Schumer. Perpetuating an honest future and positive honest role models who don’t abuse words, power, health, or other, is everyone’s job. Don’t let yourself be in doubt when something doesn’t seem congruent with truth. Don’t accept everything on social media or tv. If you let them, they will tell you exactly how much you are worth and how much you will pay them for theirs. I have no proof. Faraco is a drummer, ie, Doctor, you are Him. They have agreed to say this story as truth and it has been repeated as would the chemical composition of a new dietary supplement, but that does not mean it’s true

  15. Equipping every flight with epipens may cost, say, $2.5 million a year – but the cost of one passenger dying of allergies, even if they sue, is maybe about $5 million.

    Assuming one such incident every five years (and that’s quite a stretch), that’s $7.5 million in savings by not stocking the flights.

    Hard to justify the costs (barring the whole value-of-a-human-life thing, but this is a corporation we’re talking about).

  16. What a stressful thing to go through especially when you don’t have proper medical equipment and you don’t have proper medications working with what you have in an environment that is not meant to stabilize people is amazing you saved his life!!

  17. Doctor Mike, i work in a long term vent facility and all my patient's have had crics. Whether emergent or scheduled. Im very glad that a doctor can admit that they don't know a procedure right off!!

  18. I don't understand how people have guts to dislike his video….how on hell do there hands hit that unnecessary button….God! I hate when I see those dislike's….

  19. Uhhg…they should have asked for a paramedic or even an ACLS trained nurse. Glad you didn't cause a huge area of necrosis in his leg.
    Epi 1:1000, syringes and smaller needes are required and should have been in the airline's EMK. They have been on both occasions I've used them.

  20. Why why I’m eating a hamburger and I heard him talking about the tic and how’s it’s slowly creeping it’s way up north, UR SCARING NE MIKE

  21. When I was pregnant, I had severe anemia that required IV iron infusions. The first treatment, the nurse said the Dr ordered a ‘test dose’ – a 10 minute infusion that was just a fraction of the full treatment to make sure I tolerated it. She hooked it up and immediately got called away. Within a minute or two, I felt my throat getting itchy, then felt like I couldn’t get enough air…. then couldn’t breath. It was FAST. And terrifying. Luckily my husband was there screaming for help, and we were in a hospital. New allergies pop up. And how can you be prepared for something you don’t expect like that? Because of that experience (and several other medication allergies), I now keep an Epi pen on hand. Because I never want to experience that again. I’m so glad you were able to help Matt when he really needed it! But yes!!!! Epi Pens need to be on plains, trains, busses, ships, etc. Any place that maybe come stuck or isolated from emergency services.

  22. Well EMT's and paramedics are "trained Macgyers" why didn't you attempt Sub-Q at a 1:1000 solution shows how a doctor aren't the gods the people think they are. Com'on DR.. Mike Should you know what
    to do with an IO kit.

  23. Great adventure.
    Thanks for sharing it.
    It would be great if you could do a viewing of House S03E08 chapter called "Airborn".

  24. I almost had security confiscate my EpiPen (which I carry for a Shellfish Allergy) once because of the needle :-/ Then they nearly refused to let me board because I said it was for a food allergy and they were worried I'd have a reaction to the food they served on the plane.

  25. mike: ya so I fixed it but ya know, the real problem is lack of access to epi pens

    the real hero! explaining risks and concerns, as well as a first hand case study, but also, using his platform to describe an issue

  26. Kind of on the topic of weird or bizarre allergies, my brother has exercise induced anaphylaxis. If he exercises too soon after having a big meal, he’ll go into anaphylactic shock. We found that out the scary way

  27. I worked in Allergy/Immunology for 9 years. We do have EpiPens in the cabinet in case there's not enough time to draw up an epi injection but 99% of the time I draw up from the ampule like Dr. Mike did. It's the same med, concentration, etc but cheaper. 1 ampule holds 1mL. I draw up 2 syringes of 0.3mL or if it's a child 0.15mL. If I have a pt with oral symptoms, for example I hear them start clearing their throat or coughing, I'll ask how they're feeling (swelling? itchy? breathing?) look in their throat and no visible swelling but they describe throat discomfort. Usually 0.3mL is what I'll give (along with something by mouth, usually zyrtec, prednisone, depending on symptoms) and wait 10 minutes or so. If I already see swelling or they're having trouble breathing/speaking/swallowing (swelling down through airway) I go ahead and give 0.6mL. This is an emergent situation and the higher dose is warranted.

    HERE IS WHAT I WANT ALL MY PATIENTS TO KNOW. EpiPens come in a 2 pack for a reason. Do NOT separate them! Ex: Parents: Don't keep one at home and send one to school with your child. The whole pack goes to school and a whole pack stays at home. A lot of my patients that receive that first 0.3mL need a 2nd dose 10-15 minutes later. Along with further IV meds/fluids. The epinephrine's purpose to keep you alive until an ambulance can take you to the hospital and you can receive that additional support. If you only have 1 pen with you. That is valuable time lost holding off that reaction until you receive support. This is also why ALL patients are told that if you need to use your EpiPen you MUST IMMEDIATELY call for an ambulance. Do not try to drive yourself to the hospital or wait to call 911 because you feel better after receiving a dose. Sorry I'm a little aggro about this but I've found that a lot of physicians do not give their EpiPen patients this information about the 2 pen per pack reasoning/rule.

    ALSO! If you are in an emergent situation and your EpiPen is expired use it anyway! There was a little girl local to us and the 911 dispatcher told mom over the phone not to use her expired EpiPens on her child. Ambulance did not get there in time. In an emergency use everything available to you. There are worse things than taking an expired med. Like dying.

    Small detail as well: you don't have to undress someone to give an emergency dose of epinephrine. Don't waste precious time removing pants. Give the injection right through their jeans or whatever they're wearing.

    Another small thing but your physicians should already know this: EpiPen is only a brand name and yes it is expensive. If your insurance will not cover an EpiPen there are other types you can request and a lot of insurances will cover a generic auto-injector pen. The packaging will look different, the way to use it will be a little different but they're still simple to use and are pre-filled doses for convenience. Yes the EpiPens are nicer but for my patients that can't afford them and need to have epinephrine at home these are an option.

    Ok.. sorry. That's all I have. I hope this helps someone. I know I probably look crazy. I just don't want anyone to die due to lack of information and allergies are becoming a lot more common and also frequently underestimated for how quick and deadly they can be.

    When in doubt use your EpiPens!

  28. Why aren't airlines required to have a medical professional on board? Seems like with the fees they charge, they could afford to make sure the customers they are raping for having an extra bag, can at least get medical attention if needed.

  29. Revenge of the vegans.

    You’re scared to do a cric? In the military they taught us before deploying (non medical) how to insert a pen through the ribs into the chest wall for emergency collapsed lung. A pen. Hooyah.

  30. Israel? I’m surprised you aren’t a Jew lol my parents would love you. You’re invited to Thanksgiving. Their house 🏡! 💞

  31. Hi Mike. I was wondering, you said the epipen would have a lower dose – you said you gave him the right dose but were you able to do that because you already knew what the dose of epinephrine should be, or were there instructions in case on anaphylactic shock?

    Well done for keeping your cool and saving Matt. He’s very blessed that you were on board. I know how to give an epipen but I’d be stuck in that situation. If there were no instructions I’d have killed him by giving him the whole thing.

    I look after a lad who has a peanut allergy – he’s so good, he looks after his epipen like is a million dollars! Guess he knows how to stay happy and healthy 😀

  32. Dr. Mike if epi hadn’t worked would you have been comfortable administering a high dosage of diphenhydramine say 50mg or so? I understand it can have a sedative effect in such high dosages which would in turn force you to monitor vitals much more closely and possibly require advanced airways. Just food for thought since I’m curious.

  33. This is why I carry 4-6 benadryl with me everywhere I go. Epi-pens are too expensive. Hope I can get a generic next doctor's visit. Guess if I go into anaphylactic shock I'll just show my immune system my finances and hope it gives me a break.

  34. Unfortunately, at least in my airline, we are not allowed to open or use the medical kit without the presence and authorization of a doctor.

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