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- W2012368368 abstract "Last month I was called to assist a passenger on a flight from Boston to San Francisco, who was reported to be behaving strangely. I encountered an elderly man, washing his cell telephone with a napkin soaked in orange juice. He was alert and spoke fluently, but his speech was incoherent and he followed no commands. According to seatmates, his condition had deteriorated steadily since takeoff. Pulse rate, blood pressure, and respirations were normal. A brief neurological examination, performed while I knelt in the aisle, yielded normal results, except for altered mental status. Five sachets of sugar dissolved in juice produced no improvement. Because he was traveling alone and could not communicate, I had no information about him.I was unsure of the diagnosis but considered the possibility of acute stroke, causing a Wernicke aphasia. The copilot and I discussed whether to divert the flight to Minneapolis. The patient’s life did not appear in danger, so we decided to continue to San Francisco. The plane was met by paramedics, who transported the patient to a local hospital emergency department (ED).The next day I received a telephone call from the patient, who was completely back to normal after a night in the hospital. He explained, apologetically, that he had swallowed zolpidem 10 mg to help him sleep on the plane.Possible stroke and altered mental status account for 4.4% of in-flight emergencies.1Peterson D.C. Martin-Gill C. Guyette F.X. et al.Outcomes of medical emergencies on commercial airline flights.N Engl J Med. 2013; 368: 2075-2083Crossref PubMed Scopus (149) Google Scholar It is unknown what percentage of passengers use sleeping pills on airplane flights, but the general use of sedative hypnotics has increased sharply.2Bertisch S.M. Herzig S.J. Winkelman J.W. et al.National use of prescription medications for insomnia: NHANES 1999-2010.Sleep. 2014; 37: 343-349PubMed Google Scholar Zolpidem can produce paradoxic alertness, confusion, and automatisms.3Poceta J.S. Zolpidem ingestion, automatisms, and sleep driving: a clinical and legal case series.J Clin Sleep Med. 2011; 7: 632-638PubMed Google Scholar It accounts for 21% of ED visits for drug reactions to psychiatric medications in adults aged 65 years or older, more than any other medication.4Hampton L.M. Daubresse M. Chang H.Y. et al.Emergency department visits by adults for psychiatric medication adverse events.JAMA Psychiatry. 2014; 71: 1006-1014Crossref PubMed Scopus (7) Google Scholar Physicians should caution patients, especially those traveling alone, about the potential risks of using hypnotics when traveling by airplane. Last month I was called to assist a passenger on a flight from Boston to San Francisco, who was reported to be behaving strangely. I encountered an elderly man, washing his cell telephone with a napkin soaked in orange juice. He was alert and spoke fluently, but his speech was incoherent and he followed no commands. According to seatmates, his condition had deteriorated steadily since takeoff. Pulse rate, blood pressure, and respirations were normal. A brief neurological examination, performed while I knelt in the aisle, yielded normal results, except for altered mental status. Five sachets of sugar dissolved in juice produced no improvement. Because he was traveling alone and could not communicate, I had no information about him. I was unsure of the diagnosis but considered the possibility of acute stroke, causing a Wernicke aphasia. The copilot and I discussed whether to divert the flight to Minneapolis. The patient’s life did not appear in danger, so we decided to continue to San Francisco. The plane was met by paramedics, who transported the patient to a local hospital emergency department (ED). The next day I received a telephone call from the patient, who was completely back to normal after a night in the hospital. He explained, apologetically, that he had swallowed zolpidem 10 mg to help him sleep on the plane. Possible stroke and altered mental status account for 4.4% of in-flight emergencies.1Peterson D.C. Martin-Gill C. Guyette F.X. et al.Outcomes of medical emergencies on commercial airline flights.N Engl J Med. 2013; 368: 2075-2083Crossref PubMed Scopus (149) Google Scholar It is unknown what percentage of passengers use sleeping pills on airplane flights, but the general use of sedative hypnotics has increased sharply.2Bertisch S.M. Herzig S.J. Winkelman J.W. et al.National use of prescription medications for insomnia: NHANES 1999-2010.Sleep. 2014; 37: 343-349PubMed Google Scholar Zolpidem can produce paradoxic alertness, confusion, and automatisms.3Poceta J.S. Zolpidem ingestion, automatisms, and sleep driving: a clinical and legal case series.J Clin Sleep Med. 2011; 7: 632-638PubMed Google Scholar It accounts for 21% of ED visits for drug reactions to psychiatric medications in adults aged 65 years or older, more than any other medication.4Hampton L.M. Daubresse M. Chang H.Y. et al.Emergency department visits by adults for psychiatric medication adverse events.JAMA Psychiatry. 2014; 71: 1006-1014Crossref PubMed Scopus (7) Google Scholar Physicians should caution patients, especially those traveling alone, about the potential risks of using hypnotics when traveling by airplane." @default.
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- W2012368368 date "2015-03-01" @default.
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- W2012368368 title "In-Flight Emergency" @default.
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- W2012368368 doi "https://doi.org/10.1016/j.annemergmed.2014.11.003" @default.
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