Sunjay Kapur, friend of Prince William and ex-husband of Bollywood star Karisma Kapoor, reportedly died of anaphylactic shock after being stung by a bee during a polo match in Windsor, England.
The question I ask myself is: You have that much money,you have a private jet on standby, a large security detail.
And none fucking thought about getting competent medical team or at least a fucking competent paramedic?
I mean…I am generally unsympathetic amongst almost all billionaires, but as someone who has literally done VIP escorts as a critical care paramedic I wonder who fucked up that much.(But these were all “old wealth” and actually were not billionaires. And tbh they treated us with more respect than most members of the public do-that gives them at least some plus point)
It’s not like Airway obstruction nor anaphylaxis is untreatable/isn’t absolutely manageable if caught early.
Anyway, can we please get a fundraiser for the poor queen of that bee?
Any med school student should know how to macguyver an airway in an emergency. They literally teach it in civilian lifesaving classes these days. My guess is this guy was such an asshole, his entire medical staff was like “bruh I am not making the hole, you do it.”
I don’t know which med school or civilian lifesaving courses you attend - but emergency cricothyrotomy surely isn’t a skill that is taught and mastered by any of these I teach.
Cric is a delicate skill that needs repetition and knowledge - it’s far from easy and not even close to what is shown in some bad TV shows.
Airway management contains much more than just “getting a hole into the neck” - it starts with nebulised adrenaline (which works wonders but must be used in moderation due to the side effects), regular endotracheal intubation with a (preferably video)laryngoscope, if necessary with a tube that is resistant against swelling(woodbridge tube) before a cricothyrotomy (not a tracheotomy,see below) is performed - and is supported by intravasal drugs (mostly adrenaline, a glucocorticoid and H1 blockers, in some cases also a beta2 antagonist and a anticholinergic agent). A cric is always the last choice due to the high risk to benefit ratio.
Even a qualified responder won’t do a tracheotomy - emergency tracheotomies are extremly rare and basically only necessary when either the pharyngeal structures are damaged beyond rescue (due to trauma, cancer or some real rare diseases. This is not the case in anaphylaxis. The reasons for a tracheotomy not being used are many. It takes a lot of time,is far harder to achieve (getting between the tracheal cartilage is not as easy as it sounds), the risk of “hitting” structures that are vital to the patient are considerable (seen a patient who’s v.jug. ran over the spot) and the required training to do it is considerable - Besides ENTs and sometimes intensivists around here none therefore is even trained to do it anymore. I occasionally teach emergency surgical techniques to interns and med students and we don’t do so,beyond explaining the core concept, neither does any uni in central or northern Europe that I know of, same goes for AU/NZ.
A “cric” is far easier, but still takes some skill - both needle or open surgical cric(I would prefer the later) does require correct identification of the landmarks (which can be tough), good surgical technique and mainly: Training - lots of it. We therefore teach paramedics only a needle based approach (in combination with jet ventilation) - and tbh, most EM docs are not that “up to standard” in this technique as well - even though a cric is far easier than a trach.
The technique mentioned here will, with a 95% chance, not lead to any airway access, damage the thyroid (which bleeds like fuck) or the vagina carotica (the structure that contains the large vessels in the neck as well as the nervus vagus). If that happens the patient is usually beyond rescue. A case that, even if in cardiac arrest, had at least a slim chance of survival, will then certainly die - post anaphylaxis arrests with good bystander CPR have a somewhat improved prognosis - considering that that a laymans trach likely would diminish chest compression quality for minutes this would simply take that chance away from the patient.
Whoever thinks he needs to teach that in civilan responder courses needs to be fired - it’s not part in any curriculum worldwide as they are all more or less based on the same guidelines.
As a civilian what I know is hit the notch in hard cartilege approx 2 fingers below the Adam’s apple, incision half an inch deep, and if you get the tube in you have to breathe for them.
And that you should only do it if there are no medical people present and the person is obviously dying.
So… how do you tell an airway obstruction requiring an improvised tracheotomy and a similarly-presenting respiratory distress (resulting from, say, catastrophically low blood potassium) apart? Because if you get that wrong suddenly someone, who needed at worst an hour of IV therapy and a flintstone chewable to make a full recovery, is drowning in their own blood.
I’m assuming you’ve contacted 911 / emergency services since you know that the ambulance is 20 minutes away. In that case, the dispatcher will step you through an emergency diagnosis and if such an extreme action is warranted either they will put you in touch with a medical professional who can instruct you on safe procedure, or they will be a qualified paramedic and instruct you themselves. However that is EXTREMELY unlikely, tracheotomy are almost never warranted (outside of television) in emergency situations, as stabbing someone in the neck is not a trivial thing to do. In my region the procedure isn’t even taught to first responders (Edit: I was half wrong, paramedics still learn it but EMTs do not) (Edit 2: No, I was right! Neither are taught it) as it’s long been surpassed by modern intubation techniques and treatments like fast-acting anaphylaxis medications.
In short, follow the guidelines you are taught in your first aid class and contact emergency services. Don’t stab someone in the neck.
Eh I have no knowledge about tracheotomy besides what I’ve seen on TV but I mean if push comes to shove I’m just gonna jab a pen tube in the victim’s throat man, it’s gotta be worth a try. /s
Honestly, I think it was ignorance and/or hubris. He was either unaware of his allergy (miraculously never stung before, or developed allergy later in life), or he was kind of aware, but never assumed anything could go wrong.
“Never attribute to malice that which is adequately explained by stupidity.” – Hanlon’s Razor.
I’ve never been to a billionaire polo match [sad trumpet] but I’d assume that there be some medical staff, like you’d find at any major sporting event where injury is likely. On the other hand, I could see how the staff was prepared for a broken neck and not considering bee stings. Either way, it’s pretty funny.
This is where caring counts. We’ve all seen videos where ‘dad reflexes’ kick in and someone reacts in micro-seconds to save a kid. Medical staff was getting paid to show up and be on stand-by. They were expecting a broken leg, or other trauma.
Anaphylaxis sets in fast,but not within seconds - we are talking more like a couple of minutes and they can be treated.
Adrenaline is one component of the treatment besides other medications (that actually “counteracts” the anaphylactic reaction, Adrenaline more or less is mainly used to buy time and fight the worst symptoms).
Airway management, fluid management, etc. are other things we need to consider.
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The question I ask myself is: You have that much money,you have a private jet on standby, a large security detail.
And none fucking thought about getting competent medical team or at least a fucking competent paramedic? I mean…I am generally unsympathetic amongst almost all billionaires, but as someone who has literally done VIP escorts as a critical care paramedic I wonder who fucked up that much.(But these were all “old wealth” and actually were not billionaires. And tbh they treated us with more respect than most members of the public do-that gives them at least some plus point)
It’s not like Airway obstruction nor anaphylaxis is untreatable/isn’t absolutely manageable if caught early.
Anyway, can we please get a fundraiser for the poor queen of that bee?
It’s on the front page of GoFundBee!
Any med school student should know how to macguyver an airway in an emergency. They literally teach it in civilian lifesaving classes these days. My guess is this guy was such an asshole, his entire medical staff was like “bruh I am not making the hole, you do it.”
I don’t know which med school or civilian lifesaving courses you attend - but emergency cricothyrotomy surely isn’t a skill that is taught and mastered by any of these I teach.
Cric is a delicate skill that needs repetition and knowledge - it’s far from easy and not even close to what is shown in some bad TV shows.
As it came up here a bit of a longer explanation.
Airway management contains much more than just “getting a hole into the neck” - it starts with nebulised adrenaline (which works wonders but must be used in moderation due to the side effects), regular endotracheal intubation with a (preferably video)laryngoscope, if necessary with a tube that is resistant against swelling(woodbridge tube) before a cricothyrotomy (not a tracheotomy,see below) is performed - and is supported by intravasal drugs (mostly adrenaline, a glucocorticoid and H1 blockers, in some cases also a beta2 antagonist and a anticholinergic agent). A cric is always the last choice due to the high risk to benefit ratio.
Even a qualified responder won’t do a tracheotomy - emergency tracheotomies are extremly rare and basically only necessary when either the pharyngeal structures are damaged beyond rescue (due to trauma, cancer or some real rare diseases. This is not the case in anaphylaxis. The reasons for a tracheotomy not being used are many. It takes a lot of time,is far harder to achieve (getting between the tracheal cartilage is not as easy as it sounds), the risk of “hitting” structures that are vital to the patient are considerable (seen a patient who’s v.jug. ran over the spot) and the required training to do it is considerable - Besides ENTs and sometimes intensivists around here none therefore is even trained to do it anymore. I occasionally teach emergency surgical techniques to interns and med students and we don’t do so,beyond explaining the core concept, neither does any uni in central or northern Europe that I know of, same goes for AU/NZ.
A “cric” is far easier, but still takes some skill - both needle or open surgical cric(I would prefer the later) does require correct identification of the landmarks (which can be tough), good surgical technique and mainly: Training - lots of it. We therefore teach paramedics only a needle based approach (in combination with jet ventilation) - and tbh, most EM docs are not that “up to standard” in this technique as well - even though a cric is far easier than a trach.
The technique mentioned here will, with a 95% chance, not lead to any airway access, damage the thyroid (which bleeds like fuck) or the vagina carotica (the structure that contains the large vessels in the neck as well as the nervus vagus). If that happens the patient is usually beyond rescue. A case that, even if in cardiac arrest, had at least a slim chance of survival, will then certainly die - post anaphylaxis arrests with good bystander CPR have a somewhat improved prognosis - considering that that a laymans trach likely would diminish chest compression quality for minutes this would simply take that chance away from the patient.
Whoever thinks he needs to teach that in civilan responder courses needs to be fired - it’s not part in any curriculum worldwide as they are all more or less based on the same guidelines.
As a civilian what I know is hit the notch in hard cartilege approx 2 fingers below the Adam’s apple, incision half an inch deep, and if you get the tube in you have to breathe for them.
And that you should only do it if there are no medical people present and the person is obviously dying.
Nothing beats a layman explaining the job most professionals won’t do to a professional who does it.
BTW: This is all wrong and will make things worse. Please don’t do what this dude writes.
So… how do you tell an airway obstruction requiring an improvised tracheotomy and a similarly-presenting respiratory distress (resulting from, say, catastrophically low blood potassium) apart? Because if you get that wrong suddenly someone, who needed at worst an hour of IV therapy and a flintstone chewable to make a full recovery, is drowning in their own blood.
Thank you, this is the kind of reply I was hoping for. I would love more information.
So, if the person has completely stopped breathing, and ambulances are 20+ minutes away, should I limit my response to attempted CPR?
Is it your opinion even if they have been stung by a bee etc?
I’m assuming you’ve contacted 911 / emergency services since you know that the ambulance is 20 minutes away. In that case, the dispatcher will step you through an emergency diagnosis and if such an extreme action is warranted either they will put you in touch with a medical professional who can instruct you on safe procedure, or they will be a qualified paramedic and instruct you themselves. However that is EXTREMELY unlikely, tracheotomy are almost never warranted (outside of television) in emergency situations, as stabbing someone in the neck is not a trivial thing to do. In my region the procedure isn’t even taught to first responders (Edit: I was half wrong, paramedics still learn it but EMTs do not) (Edit 2: No, I was right! Neither are taught it) as it’s long been surpassed by modern intubation techniques and treatments like fast-acting anaphylaxis medications.
In short, follow the guidelines you are taught in your first aid class and contact emergency services. Don’t stab someone in the neck.
The answer is: YES
Eh I have no knowledge about tracheotomy besides what I’ve seen on TV but I mean if push comes to shove I’m just gonna jab a pen tube in the victim’s throat man, it’s gotta be worth a try. /s
Hell, I’d jab a pen in your throat right now if I suspected it would somehow improve your health
iirc Epi-pen is the usual treatment, and those things are pretty easy to obtain.
I think that OP philpo is on to something, that the medical staff was a bit slow to deal with the situation.
Honestly, I think it was ignorance and/or hubris. He was either unaware of his allergy (miraculously never stung before, or developed allergy later in life), or he was kind of aware, but never assumed anything could go wrong.
“Never attribute to malice that which is adequately explained by stupidity.” – Hanlon’s Razor.
I’ve never been to a billionaire polo match [sad trumpet] but I’d assume that there be some medical staff, like you’d find at any major sporting event where injury is likely. On the other hand, I could see how the staff was prepared for a broken neck and not considering bee stings. Either way, it’s pretty funny.
With anaphylactic shock, the timeline could be literally seconds. He could be dead before they even figure out what’s wrong.
This is where caring counts. We’ve all seen videos where ‘dad reflexes’ kick in and someone reacts in micro-seconds to save a kid. Medical staff was getting paid to show up and be on stand-by. They were expecting a broken leg, or other trauma.
Anaphylaxis sets in fast,but not within seconds - we are talking more like a couple of minutes and they can be treated. Adrenaline is one component of the treatment besides other medications (that actually “counteracts” the anaphylactic reaction, Adrenaline more or less is mainly used to buy time and fight the worst symptoms).
Airway management, fluid management, etc. are other things we need to consider.