# Dehydration?



## RedAirplane (May 22, 2015)

You are dispatched to a gate inside the airport for an unknown medical. 

Upon arrival the ticket agent advises you that the patient, a 64 year old female, was removed from her flight by flight attendants on suspicion of being medically unfit to fly. She allegedly asked for water twice before takeoff, making the flight attendants fear severe dehydration. 

The patient is alert, oriented, standing upright, and visibly upset. She says her husband and grandson were left on the plane which departed, and now they are separated. 

You have the patient sit and obtain some vital signs. 

HR 96
RR 20
BP 140/80

The patient has a history of MI and HTN and takes medication for these, but can't recall their names. She says she was honestly just thirsty because it was a hot hectic morning. 

Is there any reason you wouldn't clear the patient to take the next available flight?


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## luke_31 (May 22, 2015)

None that I could see.  I would gif the patient some water and see how she feels afterward


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## Carlos Danger (May 22, 2015)

Ishan said:


> HR 96
> RR 20
> BP 140/80



Those are perfect VS for a pissed off person with a history of hypertension.

I'd give her a bottle of water and advise her to sue the airline.


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## NomadicMedic (May 22, 2015)

This! ^^^

If she didn't get some free flights out of that, she did it wrong.


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## redundantbassist (May 22, 2015)

So the airline denied her water and then kicked her off the plane? Huh? I really hope this isn't a real scenario.


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## DesertMedic66 (May 22, 2015)

2 large bore IVs with a 2L fluid bolus, high flow oxygen, full c-spine, Dope and Levo drip, and rapid transport...

None of those vital signs are concerning for me or make me think severe dehydration. Have her sign AMA, get her a bottle of water, and have her talk to the airline about it.


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## medichopeful (May 23, 2015)

Remi said:


> Those are perfect VS for a pissed off person with a history of hypertension.
> 
> I'd give her a bottle of water and advise her to sue the airline.




Hell, those are pretty perfect vital signs for a pissed off person withOUT a history of HTN! 

If this really happened, a complaint needs to be filed.  That's utterly ridiculous!


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## RedAirplane (May 23, 2015)

It is a real scenario. I remembered it as I had to travel in an airplane today. (Obviously details altered/scrubbed but the whole business about being kicked off a plane... Can't make that up)


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## zzyzx (May 25, 2015)

I would be suspicious that there is more to the story.


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## Ewok Jerky (May 26, 2015)

I would write a detailed pcr documenting the superb fitness of this individual, and complete a Released At Scene as opposed to an AMA.


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## zzyzx (May 26, 2015)

In my experience, you have to be really careful about calls like this where the story initially sounds ridiculous. You really have to put on your detective hat and dig a little deeper to see if there is more to the story. It makes no sense that someone got kicked off a plane for asking for water. Often in situations like this, you are getting the story from a poor historian, or someone who is actively trying to downplay their symptoms. Or, you are getting the story second hand from someone else, and there may be something lost in the translation. 

In this situation (which the OP says is a real scenario), I certainly wouldn't medically clear her since I don't have an MD after my name.


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## johnrsemt (May 26, 2015)

If the Airline/gate attendant called 911; of course you can do a refusal.  The patient didn't call and doesn't want you there;  clear her with a 'pt refused contact' and let her get on next flight.
I don't remember how many times I have had people call 911 because friend/coworker didn't look right, or acts sick; and there was nothing wrong with the person we were called for.  We didn't do much of a workup, if anything at all.  Sometimes the patient was downright pissed about the whole thing and I didn't blame them.
I would be extremely pissed if I was told to get off a plane because the Flight Attendants didn't want to deal with me and requests for water, although it makes you wonder why she didn't just use drinking fountain before she got on flight


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## RedAirplane (May 26, 2015)

The story was given by the airline employees and vetted by the passenger. She was in first class and this all happened during the pre departure drink service, the whole thing struck me as odd. 

I was off duty and overheard the call for paramedics. Thinking something worse was going on, I asked if anyone needed assistance. 

And sure enough, once airport ALS arrived, it was a quick V/S and release to the next available flight... Which would be too late for the special event she was taking her grandson and husband to see. 

This was years ago, but I was reminded of it recently in an airport. 

So I guess most likely nothing to be worried, but still seems a little odd.


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## johnrsemt (May 26, 2015)

add it to the list of many 'odd' runs you will get over your experience.   Makes life more interesting; and one of many things that I miss where I work now.


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## zzyzx (May 27, 2015)

I'm surprised you guys are so willing to just blow this off. I'm totally not one of these "what if" guys that insists on doing a 12-lead on every 15 y/o with toe pain, but I think you have to tread carefully with seemingly BS calls like this. 
Just because the patient didn't call 911 doesn't mean you don't have to do an assessment. If she were to refuse an evaluation, that is another thing, but to just document it as "no medical aid needed" without doing any assessment is pretty risky. Likewise, you can't medically clear the patient because we are not doctors and don't make an official diagnosis.

Why not just talk to the patient, and most importantly, try to get the story from someone else as well? (I understand that in this scenario it may not be possible.) Really, her story makes no sense. Yes, people are stupid, and perhaps these flight attendants were morons, but to approach something like this an attitude of "just another BS call" is something that will eventually burn you. I could think of all kinds of things that could have happened that she is not telling you either because she doesn't remember or because she doesn't want to miss the next flight. Maybe she was pale and diaphoretic asking for water and just looked really unwell to the flight attendents, or maybe she had a syncopal episode. Likely the decision wasn't made by a single flight attendant, which is another thing that would make me wonder why she was taken off the flight.

Take vital signs, do a 12-lead, try to get a complete history. As presented, I would certainly not try to influence the patient to go to the ER. Tell her, "From looking at your vital signs and our limited diagnostic tools, there is nothing obviously wrong with you. However, since someone was concerned enough about you to call 911, I suggest that you receive a full evaluation at the ER. However, that decision is entirely up to you." When she signs the AMA, simply document all that and not only are you covered from liability, but you have also done your duty to look out for your patient's best interest by giving her a proper evaluation.


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## DesertMedic66 (May 27, 2015)

zzyzx said:


> I'm surprised you guys are so willing to just blow this off. I'm totally not one of these "what if" guys that insists on doing a 12-lead on every 15 y/o with toe pain, but I think you have to tread carefully with seemingly BS calls like this.
> Just because the patient didn't call 911 doesn't mean you don't have to do an assessment. If she were to refuse an evaluation, that is another thing, but to just document it as "no medical aid needed" without doing any assessment is pretty risky. Likewise, you can't medically clear the patient because we are not doctors and don't make an official diagnosis.
> 
> Why not just talk to the patient, and most importantly, try to get the story from someone else as well? (I understand that in this scenario it may not be possible.) Really, her story makes no sense. Yes, people are stupid, and perhaps these flight attendants were morons, but to approach something like this an attitude of "just another BS call" is something that will eventually burn you. I could think of all kinds of things that could have happened that she is not telling you either because she doesn't remember or because she doesn't want to miss the next flight. Maybe she was pale and diaphoretic asking for water and just looked really unwell to the flight attendents, or maybe she had a syncopal episode. Likely the decision wasn't made by a single flight attendant, which is another thing that would make me wonder why she was taken off the flight.
> ...


None of us here are really stating just walk walk away after asking if she is ok. We all stated to do an assessment (vitals were already given to us which means some kind of an assessment was done). Document your findings, get a story from someone who saw what happened, and then let her sign AMA if she so wishes. 

I didn't read anyone's post that said to just blow her off.


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## Carlos Danger (May 27, 2015)

She's alert and oriented and said she's just thirsty. Her VS are fine. The fact that you have that info implies that an assessment was done. She's good to go, as far as I'm concerned.


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## RocketMedic (Jun 5, 2015)

I wonder about skin tone, oral mucosa, temp and glucose. If those are WNL, I see no reason not to fly.


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## scotchawe (Jun 23, 2015)

DEmedic said:


> This! ^^^
> 
> If she didn't get some free flights out of that, she did it wrong.


What a comment... )


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