Account is misleading and condescending

EDITOR—Dunea's account of a “crisis in the air” makes slightly disturbing reading.1 He describes a scene surrounding the collapse of a young woman on an aeroplane, who appears pale, “dead, or dying,” with dilated pupils. A dentist is organising cardiac massage, elevation of the legs, and facemask oxygen while personally attending to the patient's airway. Whatever the cause of the collapse, this represents an admirable ABC approach to the problem in difficult circumstances. However, Dunea goes on to describe how he instructed various individuals to discontinue their efforts, ascribing the whole incident to an atropine-induced bradycardia and faint.

This uncomplimentary account of the dentist's management is both condescending and misleading. If the woman did indeed suffer a vasovagal syncopal attack (atropine is an anticholinergic agent more likely to cause a tachycardia than a bradycardia), then the prompt intervention by this resuscitation team in a partially pressurised and relatively hypoxic air cabin should be praised, not subjected to scorn.

Faced with the prospect of being resuscitated by the physician or the dentist, I think I would opt for the latter.

Automated defibrillators are safer than levitating dentists or horizontal internists

EDITOR—Much as I usually enjoy George Dunea's perceptiveness, I have to take issue with his assessment of the role of automated defibrillators.1

The case he outlines is the perfect testimony as to why automated defibrillators are potentially useful. The machines currently available analyse rhythms and give verbal instructions to bystanders. They are likely to perform better than the levitating dentist portrayed.

Parenthetically, although low doses of atropine that have been administered slowly can cause paradoxical bradycardia, tachycardia is more usual. Many remedies for motion sickness contain antihistamines, which can be associated with atrioventricular and bundle branch blocks as well as tachycardia, and the common “cure-all” Donnatol contains barbituate, atropine, scopolamine, and hyoscine.

All the more reason for the elegant simplicity and safety offered by automated defibrillators.