"I can't breathe!"

[exodus]

I was reading this post and was thinking, if the cells simply aren't perfusing, wouldn't the person start to feel light headed, get a head ache, etc. And not scream I can't breathe? Because they can't tell that they can't breathe and they don't know that it's because the oxygen is getting to the cells. But they do know that they ARE able to take breaths, which from an everyday person, I would think that is considered as "Breathing".

Obviously, I'm going to treat this patient like an SoB pt and not any differently, but isn't there more likely to be pysch problems too?

 

[vquintessence]

Sure, it'd be possible during acute stress situations. If they are at the point where they're not too deprived and can cooperate, just try explaining what's happening, why you're doing what you're doing, and how they can help. Their mother will love you!

Seriously though, on any call if we're explaining our process and why we deem them necessary, the pt will be very appreciative. I get laughed at for talking to the "poor GCS or baseline AMS pts" I tech, but on more than one occassion we've been thanked by the pts, and more often their families.

 

[Sasha]

I was reading this post and was thinking, if the cells simply aren't perfusing, wouldn't the person start to feel light headed, get a head ache, etc. And not scream I can't breathe? Because they can't tell that they can't breathe and they don't know that it's because the oxygen is getting to the cells. But they do know that they ARE able to take breaths, which from an everyday person, I would think that is considered as "Breathing".

Obviously, I'm going to treat this patient like an SoB pt and not any differently, but isn't there more likely to be pysch problems too?

Have you never felt like you're not getting enough air but couldn't tell why? We don't simply shout "My H&H is low! I can't oxygenate my tissue!" Or "I'm not perfusing! HELP ME!". There's a lot more to breathing than just the mechanical movement of air.

 

[BossyCow]

Anxiety is very real to the one experiencing it. If you do not convince the patient that you are taking them seriously, they will get much worse. Anxiety pts believe they are dying.

 

[VentMedic]

This is the difference between ventilation and oxygenation. You can ventilate well enough to scream. When I hear a scream, I know the airway is patient but they may still need intubating because of an oxygenation problem that will require special technology and meds.

Do not write patients off or assume anxiety is the only cause for shortness of breath all by itself. That can be a deadly mistake.

 

[OzAmbo]

The mechanism responsible for the sensation of short of breath is very poorly understood, so the does not necessarily have to be a VQ mismatch for somone to feel SOB

 

[fma08]

This is the difference between ventilation and oxygenation. You can ventilate well enough to scream. When I hear a scream, I know the airway is patient but they may still need intubating because of an oxygenation problem that will require special technology and meds.

Do not write patients off or assume anxiety is the only cause for shortness of breath all by itself. That can be a deadly mistake.

Beat me to it... My thoughts exactly.

 

[VentMedic]

The mechanism responsible for the sensation of short of breath is very mis-understood

Fixed that for you. There are many reasons for shortness of breath but assumptions and lack of knowledge about even the most basic causes are not well understood by some healthcare providers.

 

[MSDeltaFlt]

I was reading this post and was thinking, if the cells simply aren't perfusing, wouldn't the person start to feel light headed, get a head ache, etc. And not scream I can't breathe? Because they can't tell that they can't breathe and they don't know that it's because the oxygen is getting to the cells. But they do know that they ARE able to take breaths, which from an everyday person, I would think that is considered as "Breathing".

Obviously, I'm going to treat this patient like an SoB pt and not any differently, but isn't there more likely to be pysch problems too?

Yes and no. Your body will begin to not work properly before you feel it, and you can feel it before it becomes painfully obvious to those around you, but not always. It's not like the body suddenly flipped a switch and blam! The cells aren't perfusing and the pt can't breathe.

Every now and then, the family may call you for them because the pt doesn't realize they're that sick. Even though it may be painfully obvious to everyone but themselves.

It's never cut and dry. It is an evolving process that you might encounter anywhere from the beginning stage, to the middle stage, to the end stage of compensating up to and including the stage where the body says, "Screw this. I quit". And they lose their VS.

This is where pt assessment is critical.