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Hospital ER question
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pljohns posted:
I have a really stupid question for anyone that has had to go to the ER with an asthma attack-what exactly do they give you? I got hit REALLY bad last night after multiple triggers hit at the same time. I should have gone to the ER, but it was super late. I didn't know what they'd do there, so I hit an albuteral neb. It took 2 to get it settled back down and of course, I shook the rest of the night. What else could the ER have done?
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bresky responded:
Hi Pljohn

I understand your concern and its not a stupid question. When I have gone to emergency depending on how bad it is they often give me ventolin nebs one right after the other but monitor my heart rate very closely. I also get oxygen if my oxygen levels are low and I get iv steroids as they work the best for me. Often they will do blood work and a chest dray to make sure there is no underlying infection.

I hope your feeling better and if is not improving make sure you see your doctor because u might need prednisone.

Let me know if you have any more questions there are no stupid questions.

Bre
 
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DUKE MEDICINE
Michael H Land, MD replied to bresky's response:
Hi pljohns and bresky,

This is a great question and I agree with Bre completely. Most of my patients with severe asthma who have had to go to the ER will be closely monitored to make sure the attack is not getting worse, to possibly get steroids on board, to make sure there is not an infection like pneumonia that they think is their asthma, and to evaluate for other causes of their symptoms. I don't know how old you are pljohns, but when my older patients who have heart disease develop chest tightness and trouble breathing, sometimes it is a heart attack and not their asthma (or it's both), so this can be checked for with an EKG and labs.

Sometimes, you might need a nebulized treatment of something other than Albuterol if your asthma attack is very bad (i.e. Ipratropium, Heliox, or regular Oxygen can be given).

If you're having these types of attacks fairly frequently, you should bring this up with your regular doctor to get your symptoms under control so that this type of attack won't occur in the future.

Everyone knows that the ER is a place to go when you have an emergency like a trauma or car accident or a heart attack, but there's sort of a "grey zone" for other conditions where oftentimes people are worried about (1) how long the wait is going to be, (2) are they going to do anything more than what I can do at home, (3) how much is it going to cost, (4) could I just wait until the next morning and go to my doctor? (5) is my problem serious enough to need ER care? and others.

I think the best thing the ER can do (for any condition) is to make sure if you have a life threatening disease (i.e. asthma), that it does not kill you. Asthma is one of those types of problems and my recommendation to my patients is that if the symptoms are not controlled enough that you don't get enough relief from your rescue inhaler, you should get it checked out.

If you work with an asthma specialist, they can develop something called an Asthma Action Plan which is a detailed protocol on what to do if your asthma gets out of control--you can check your peak flows, use rescue doses, possibly take steroids, and if it is still not better, then you'd know when you should go to the ER. I develop asthma action plans with many of my patients who have severe asthma so they know what to do in severe situations.

HERE is a link for more information about this from WebMD. I hope this helps!
Good luck,
Michael
 
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amcate responded:
I've been in emergencies, but as I'm from an area where the ER is overloaded, normally the asthma specialists have a number you call and they call in medicines to try to prevent you from having to go there, or they tell you to go to urgent care. This is not to discourage anyone from going to the ER, but just mentioning how the medical community in the area I grew up in tried to manage it. So, I myself have not been to the ER.

Normally, when my rescue inhaler stops working (the meter dose inhaler), then I use a nebulizer as a backup. It has albuterol combined with ipratropium bromide and the side effects are a lot, with shaking and all that, but it is very good at reversing the attack. I also will take some oral corticosteroids, which normally take effect after three hours. The asthma has never failed to respond to the nebulizer.

When I've been to urgent care, the only other thing they offer is an injectable form of corticosteroids. But since I've already taken the oral form before going there, they skip it. Sometimes they'll suspect infection, and give me Levaquin. However, from what my doctor tells me using Levaquin with prednisone has some risks to it.

So, in urgent care they add corticosteroids and maybe an antibiotic.
 
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pljohns replied to amcate's response:
Thank you all for your reply. I've been fortunate and have never had to go to the ER with an asthma attack. I am an otherwise healthy 47 year old that has adult onset-non intrensic, severe persistant, uncontrolled asthma(geeze, that's a mouth full!) Having said that, I also have a HUGE list of meds that I'm allergic to-including all of the combo meds for asthma and yes, they were allergic reactions and not side effects of the meds. I've only had asthma for a little less than 2 years and it's been tough going. I am able to use Brovana neb (LABA) along with QVAR for fairly good control. It is a work in progress and always will be.

Recently, my albuteral inhalers quit working as rescue inhalers. They will keep the attack from getting worse, but won't make it any better. I've had to resort to carrying a neb all the time (thank goodness for handheld units). Because it is non-allergic asthma, I never know when it's going to hit and have no idea what flares it off. I have been allergy tested (both skin and blood) and have no allergies. That has only led to more frustration.

I am working with an asthma specialist and do have an action plan. It will be updated at my Oct. appointment to reflect the neb instead of inhalers. I check my peak flow's twice a day and generally know where the limits are before I have problems and definitely what the limits are that I need to see the doc.

I am constantly exposed to whatever is going around-not only do I manage a family med. practice, I also work front desk. It's amazing how many people will sign in and cough or sneeze right in your face! I get flu shots yearly and intend to get pneumonia this year, as my asthma has been worse than usual. I exercise regularly (active in martial arts) and am able to work outside in my yard pushing a mower for around 3 hrs when the yard needs it! All in all, my life goes on and I'm grateful for that.

As long as I don't have an attack, I'm OK-when they hit, they go from 1-2 symptoms to full blown within 5 min. I have cut my LABA back to once daily from twice and I find I have no time to "head off" an attack. Once those first few symptoms appear, it's already too late to head it off. By then, it's a matter of hitting the neb NOW. I do keep albuteral and atrovent for my nebs and have been instructed when to use them, so at least I have that. I also keep oral steroids to use as a last resort. Because of the type that I have, my allergist/immunologist keeps me armed with everything I might need.

Thanks for your help and suggestions
Lynn
 
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amcate replied to pljohns's response:
Thanks for the clarification. I have moderate to severe persistent asthma, and have not really met anyone who is familiar with that before, other than the asthma doctor I go to. For years, I've had to answer questions from those without asthma about asthma management, or why I'm all of a sudden leaving a meeting to get a peak flow reading, or what have you. I've been to urgent care, but the regular doctor said don't go to the ER unless I'm taking more than 6 neb treatments in a 24 hour period, and that's never happened.

I understand about the issue with folks coughing in your face. I work in a hospital (but not the ER), and started to wear a mask to block bacteria. Once on the elevator, a person said, "it makes me feel uncomfortable that you wear a mask. No one else wears it." He said it almost yelling at me, and very angry. I responded poorly, and said, "well, what makes me feel uncomfortable is when someone with bacterial pneumonia coughs right in my face, and my asthma exacerbates, and then I can't breath. That's what makes me feel uncomfortable." One of the doctors in the elevator laughed, and said, "I think she has you on that one." The guy became very quiet. I got asthma after being trained in my speciality with a master's degree. If I had known I was going to get asthma, I would have gone into a different field.

Best of luck to you.
 
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medicfdny123 responded:
Depending how bad it was they might give you some steroids along with nebs.
 
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medicfdny123 replied to Michael H Land, MD's response:
I have been diagnosed with severe advanced asthma about 20 years ago and hyper responsive airway disease. Any and everything sets me off. I been asthma free for 8 years after moving out of state. recently it is acting up again. my question is would i be wrong telling doctor how intense treatment i recived to clear it?


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