By Linda Lacey, AANA PR and Communications
The job of a Certified Registered Nurse Anesthetist (CRNA) entails far more than putting patients to sleep (and waking them up). With a background in critical care nursing in addition to extensive education and training in nurse anesthesiology, CRNAs bring a unique set of skills, knowledge, and perspectives to caring for the whole patient in a wide range of settings and circumstances.
On a recent flight, Garry Brydges, PhD, DNP, MBA, MHA, CRNA, ACNP-BC, FAAN, FAANA, a member of the American Association of Nurse Anesthesiology (AANA) since 1999, was called upon to use all his skills, knowledge, and experience as a CRNA, nurse, advocate, educator, and mentor to save the life of a passenger.
Brydges is the director of Quality and Outcomes in Anesthesia and served as the chief nurse anesthetist for 17 years at MD Anderson Cancer Center in Houston, Texas. He is a former president of the AANA and is now the vice president of the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA).
The plane had just taken off when Brydges noticed a commotion at the front of the plane. He did not think anything of it at first and went about his business getting settled. Suddenly, a request came over the loudspeaker asking if there were any medical professionals on the plane.
Brydges stepped forward to help, identifying himself as a CRNA. As he made his way to the front of the airplane to help, he learned that a passenger had become disoriented and then unresponsive upon takeoff. When he first saw the passenger, Brydges said, “His respiration and heartbeat were so shallow that I thought he was dead.” He quickly asked if there was an oxygen tank on board. When a staff member brought the tank over, Brydges realized that it was “about half the size of what we normally use when transporting patients from the OR. There was about 60 minutes’ worth of oxygen in the tank.”
Faced with a gravely ill patient in an airplane thousands of feet in the air, Brydges used what limited equipment he had available combined with years of experience, skills, and knowledge as a CRNA and critical care nurse to save the passenger’s life.
Brydges used repeated jaw thrusts to manage the patient’s airway, and through an iWatch, he was able to perform an electrocardiogram, which showed that the patient was bradycardic with low oxygen saturation. He asked if the airplane had a defibrillator, thinking “I need to know if he has a rhythm for the entire flight” and was relieved when the AED showed “a rhythm, but no shock needed.” He and a nurse on the flight were able to give the patient intravenous fluids.
Before he could determine the best action, Brydges had to narrow down as well as he could the cause of the passenger’s distress. He learned from the stricken passenger’s sister and girlfriend, who had accompanied him on the flight, that the man had stage 4 cancer.
Brydges asked the passenger’s frightened companions about any medications he may have taken. They showed him labels of the medications the passenger had brought along: lorazepam (Ativan), morphine, and haloperidol. Before the flight, the passenger had taken morphine, “which probably would have been OK alone,” according to Brydges. However, to quell his anxiety about flying, the passenger also took haloperidol.
Brydges’ extensive knowledge of pharmacology as a CRNA came into play, and he realized that the interaction of the two drugs may be what put the passenger’s life in danger. He says that part of his job is to educate patients and families, and while he was working to stabilize the passenger, he talked to the passenger’s sister and girlfriend, answering their questions and discussing their concerns. He explained about drug interactions of haloperidol with morphine and suggested safer alternatives for managing anxiety.
The pilot decided to continue the flight to Houston with about one hour to landing. Brydges stayed by the passenger’s side throughout the “extremely tense” remainder of the flight.
With the help of flight staff, Brydges raised the passenger’s legs to improve blood flow to his heart and brain. “After about 10 minutes, with the oxygen he was on and IV fluids we gave him, he started to come around,” Brydges recalls. “I kept calling his name, asking him if he could hear me,” Brydges said. “He went from initially not responding to squeezing my hand and talking to me. I asked him his name, where he was from, and he was able to tell me. I asked if he was in pain, and he said no.”
On the descent, the passenger’s sister told Brydges that “A miracle happened today.” Brydges asked her what she meant, and she said: “The miracle was that you were on this flight with us and you’re clearly passionate about what you do, and you jumped right in and explained everything to us.” “I told her ‘Thank you, we don’t hear that a lot.’”
Upon landing, Brydges handed off the patient to the waiting Houston Fire Department EMTs, reported what had happened. As the EMTs took the patient to the waiting ambulance, he gave Brydges a thumbs up sign.
Brydges’ night didn’t end there. One of the fire department EMTs asked him if he could talk. “He told me ‘I was impressed with what you did there, taking charge and reporting out. That’s what I want to do.’” The EMT said he was interested in a nursing career. Brydges talked to him at length about the rewards of nursing, especially being a CRNA. “I told him that’s what we do. We take charge.”