Bad Asthma

[Jon]

Originally posted by Wingnut@Oct 6 2005, 10:51 AM
It's kind of like that resp distress call you get at 4am. Walk into the person's house and get, he's had trouble breathing for 3 days! (I would just LOVE to ask, why didn't you take him to the doc then, during the day, when it started, instead of waking us up??)

- This is from the "Here I am Shaking My head Again!!" thread.

Seeing this reminded me of the "holy crap" call I was on last Saturday night.

We were dispatched for Resp. Diff at a residence. Pt weighs 300+ lbs, SOB increasing x 3days, at least.

Back-to-back albutorol nebs x3 prior to EMS arrivial. BLS (ME) and ALS onscene together.... lungs are diminished with slight wheezing heard..... but almost not able to hear anything. Pt. states she has Asthma, and this had been getting worse for at LEAST 3 days..... is on 2lpm O2 v/ NC and the air compressor for the neb.

Pt. seems to REALLY be getting tired, and that is BAD

Neb onto o2, pt to ambulance (and the medic is freaking out.... great guy, but gets excited). I look at my partner and tell him he better run hot to the hospital (protocol is Class III unless told otherwise). The medic has a student, and we transport. - gets an IV and another neb enroute.

At the ED, pt. goes to a code room.... and the staff ALL know her.... .

She gets another neb---- combivent this time, and gets solumedrol IV, with Mag to follow.


Later I ask what happened, thinking she was in the running for a tube.... apparently 125 of solumedrol and a gram of Mag got her back, and she got admitted at least overnight..... VERY good save on the ER staff.

Jon

 

[Wingnut]

Wow, sounds like an exciting call.But 3 days?? She's got to know what shape she's in....she didn't think to GO to the doc when it started getting worse??

I got to go on a call very similar to that. Guy got real tired in the rig and we had the airway kit out ready for him to go down.

I hate to say I was a little dissappointed that he didn't, I would have loved to establish an airway...but only a LIITLE I'm glad he made through it without incident.

 

[TTLWHKR]

Personally, I would rather take in a code, than someone with a full blown respiratory problem. The worst calls are always resp.. But it keeps ya on your toes, the conscious patient who cannot breath will be looking for your help real quick. And it just works you harder than most patients.. maybe a good trauma would be worse.

I had horrible asthma attacks when I was a child.. I was lucky b/c my father was a paramedic, mother is a nurse, and all of my siblings were already in EMS, or ended up there. Otherwise I'd probably be dead. Worst feeling in the world, it's like breathing through a tiny tube. -kow- I hope I never have to go through that again. Nothing ever worked to control it, just had to do the nebs, inhalers, injections, etc and wait it out. Last attack was like 20 years ago, I had chicken pox, I was wore out and really sick. All I remember was it was like 2 or 3am, I was awake b/c I had a really high fever. I started to cough, which is how it started usually, and then just hit me like a truck. Didn't have the strength to go through it, and it gets really fuzzy at this point. They claim I wasn't breathing, and I ended up intubated in the ER. I was in the hospital for two weeks, and after that I never had an asthma attack again. Gladly.

 

[Chimpie]

When I was twelve I had my BIG asthma attack.

I went to the hospital that mornnig for difficulty breathing and got a breathing treatment, went home and took it easy. LONG story short (cause it is a long one) my parents decided that I wasn't doing well and that I needed to go back to the hospital, about a 30 min. drive from home. I didn't think I was having problems but whatever. Half way there I knew I was in trouble and was saying goodbye to my parents. I don't remember the rest of the ride but I was told that when we arrived at the hospital my mom dragged me into the ED and they took me right in. When I was 18 my mom finally told me that they were about 10 seconds away from traching me because they couldn't get any air into me. I don't remember any of it. I thought I was unconscious, but my mom said I was awake the whole time.

Which brings up an interesting fact. I had asthma for 9 years, ages 3 to 12, and was hospitalized 5 times and had numerous other visits for breathing treatments. I don't recall, then or now, what it was like when I was having my attacks. It's like I blocked it all out. I mean, I remember being in the hospital, but I don't remember the attack that got me there.

But like Alex, after my big one I never had asthma problems again. Sure I took my inhaler every now and then but I never had an attack. Heck, when I was 16 I started smoking and was at about a pack a day with no problems. Weird.

 

[Jon]

Yeah.

This is something I've not really seen before..... I've seen asthma, but never this bad.

This Pt. was REALLY, REALLY, REALLY PCL. i was worried that we'd be doing the "PVC Challenge" in the truck.


On a related note, the county I did my ride-time just started a new protocol for Solu-medrol and Mag IV / IM for Moderate to severe asthma. The command doc were I did my ride time is REAL big on giving it to the "moderate" asthma cases, because they will otherwise sit in the ER for an hour, until it gets worse, before the doc will see them and order steroids, and then the nurse must "get around to" giving the med...... Unfortunatly, my county isn't this proactive. No Solumedrol, and Mag isn't indicated.... gotta love "Stone Age" EMS .

Jon

 

[Phridae]

I've got asthma, and I don't think I've had a really bad attack (yet) I've had a few nice ones. They always start slow. And on weekends. When I'm outside. I had pneumonia when I was in 6th grade and thats when they first said I had asthma. Never bothered me until I was in 8th grade. I went on a feild trip on a Friday. We were doing all sorts of climbing in trees and through rope mazes and stuff. It was one of those "work together" trips. Then I went up to my dads for the weekend. Him and my step mom are big smokers. I remember thinking I was getting a cold, because I was coughing and had a runny nose. But the next morning it was horrible. I remember thinking how hard it was to breathe. My dad and step mom took my step sister to her balls games, thinking I was laying around with a cold. I called my mom crying because I couldnt breath. When my dad got home it was another 4 hours before he decided to take me to the ER, 30 miles away. I was on lots of drugs after that. And now I've got bronchitis and I've never used my fast acting inhaler so many times in my life.

 

[Wingnut]

Originally posted by Phridae@Oct 9 2005, 02:17 AM
I've got asthma, and I don't think I've had a really bad attack (yet) I've had a few nice ones. They always start slow. And on weekends. When I'm outside. I had pneumonia when I was in 6th grade and thats when they first said I had asthma. Never bothered me until I was in 8th grade. I went on a feild trip on a Friday. We were doing all sorts of climbing in trees and through rope mazes and stuff. It was one of those "work together" trips. Then I went up to my dads for the weekend. Him and my step mom are big smokers. I remember thinking I was getting a cold, because I was coughing and had a runny nose. But the next morning it was horrible. I remember thinking how hard it was to breathe. My dad and step mom took my step sister to her balls games, thinking I was laying around with a cold. I called my mom crying because I couldnt breath. When my dad got home it was another 4 hours before he decided to take me to the ER, 30 miles away. I was on lots of drugs after that. And now I've got bronchitis and I've never used my fast acting inhaler so many times in my life.

Sounds like the pollen outside is getting you. Jason has sinus trouble and if the pollen and mold counts get high, he's miserable for days.

And yes, it ALWAYS happens on weekend.

Damn Murphy...damn him to hell!!!!