Have you ever had an asthmatic patient come to the ER and you just knew they were home the past 24 hours puffing on their inhaler. When you question them they say, "I thought I could handle it on my own."
Or, perhaps you are an asthmatic, COPD or CF patient who was short of breath and stayed home thinking you could take care of it on your own. You puffed on your inhaler instead of following your asthma action plan. Your gut said you should go to the ER, but you second guessed yourself.
I have been on both sides of this aisle. I've been the asthmatic who stayed home when he should have gone to the ER. I've been the asthmatic who "almost" waited too long. And I've been the RT many times whose seen the asthmatic come in too late.
In fact, many times I'm the only one in the ER the bronchodilator abuser can't fool. They can't fool me because I've been there.
In either case, based on my personal and professional experience, I have come up with five tips for any person who is short of breath that will help them decide when it is time to go to the ER.
You RTs can share these tips with your asthma patients. And, you patients can use these. Trust me, I have tried all of these and they work.
So, that in mind, my most recent column over at MyAsthmaCentral.com is titled, "Having asthma symptoms? Here's five tips to help you decide what to do." Please click here and I will morph you on over to my asthma blog.
Having asthma symptoms? Here's five tips to help you decide what to do
by Rick Frea Wednesday, January 28, 2009 @ MyAsthmaCentral.com
One of the most difficult decisions to make as an asthmatic is this: "When should I call my doctor?" Or, "At what point in the progression of asthma symptoms do I decide to go to the ER?"
Obviously if asthma hits hard and fast the answer is easy: "You GO RIGHT TO THE ER NOW!" In fact, you may even be justified calling an ambulance.
However, most asthma attacks progress over a period of time. And many times you are having an attack and can still function. You may not be comfortable, but you are not yet miserable.
Then, over time, you become a little more winded. Now you think you're worse than you've been in a long time. Now you're coughing. Now your chest feels tight. Now you think your respiratory rate has increased. Yet, you still don't really WANT to go to the ER. Right? No one does.
I'll tell you from personal experience that deciding what to do when your asthma is acting up is never easy. In fact, just the other day I was working and there was a microwave fire in the critical care unit. The unit filled with smoke.
The nurse working there had an asthma attack. She came to me hoping I would give her a breathing treatment. I said, "You need more than a breathing treatment. You need to go to the ER."
"But," she said, "I don't think I'm that bad."
"Trust me," I said, "You need to go to the ER."
Ironically, I repeated this same scenario with the other CCU nurse later in the night. While they both knew they had asthma, and were both gallant asthmatics, they still needed assistance deciding what to do.
No asthmatic is an exception to this rule, including myself. Even while I'm a lifelong asthmatic, there have been many times I've had trouble making the decision of what to do for my asthma.
Yes, it sounds like this would be an easy decision. But, trust me, it is not. So, that in mind, I would like to provide you with five tips that should help you know when it's time to go to call your doctor or go to the ER:
1. Ask a friend. I don't care how much of an asthma expert you are, it is never easy to make such a decision on your own. It is far easier to tell someone else what to do than to make the same decision for yourself. I have done this many times, and so have many of my asthmatic RT and RN co-workers.
2. Use your peak flowmeter. Of course you were a gallant asthmatic and determined your personal best, "or highest number you regularly blow," when you were feeling good. Right?
(If you want to learn more about how to use a peak flow meter, click here. If you want to determine your own personal best and how to use it to decide what to do, check out this link to nationaljewishhealth.com.)
According to National Jewish Health, every asthmatic should blow into his pf meter twice a day first thing in the morning before you take any meds, and before bed. After two weeks, you take the highest number that you blew and this is your personal best.
Now, when you blow 80-100% of your personal best, you are good to go. When you blow 60-80% of your personal best, you should use your rescue inhaler, wait 20-30 minutes, and blow in your pf again. If your pf is now above 80%, you are okay for now, but you should use your pf every four hours.
However, if your pf is still below 80%, you should call your doctor.
When you blow in your meter and your pf is less than 60%, you should use your rescue inhaler and then have someone take you to the ER. Or, if you are bad enough, call an ambulance (you should avoid driving yourself to the ER).
3. Inhaler overuse. If your asthma is so bad that you have to use your rescue inhaler more than recommended (click here for proper use of rescue inhalers), it's time to at the very least give your doctor a call.
4. Second guessing. When you start to second guess what you should do, it's time to go to the ER. Likewise, if you are thinking things like the following, go to the ER: "One more puff of my inhaler and I'll be fine." Or, "If I just wait another hour I will turn the corner."
Or, perhaps you have caught yourself saying this a time or two: "If I go to the ER they'll just make me feel stupid. I'm not sick enough to go to the ER."
Look, if you follow your asthma management plan, and it is not working, then you should come in to see us in the ER. At the very least we will give you one Albuterol breathing treatment and send you home and you will have peace of mind knowing you are okay.
5. Downplaying your asthma. "Oh, my asthma is not bad enough to go to the ER." If you find yourself saying things like that, then chances are you are downplaying the severity of you asthma and it's time to go call your doctor or go to the ER.
I think downplaying and second guessing are the two most common reasons asthmatics don't come into the ER when they should. It is true your asthma might get better, but it is also true that your asthma might get worse. It's a gamble. If you wouldn't recommend your friend bet on staying home, don't do it yourself.
Most ER docs, and most RTs and RNs who take care of asthmatics (myself included), would much rather you come in with mild asthma symptoms than to have you come in after waiting three days gasping for breath -- or not breathing at all. It's much easier for the ER staff to fix and send you home if you come in with mild asthma symptoms than if you wait too long.
You should never be afraid to call your doctor and ask for his advice. Likewise, you should never be afraid to come to the ER and seek out our services. We will never make you feel unwelcome no matter how "mild" your asthma attack is.
The questions "When should I call my doctor," and "When should I go to the ER" should be easy to answer. If you are among the many asthmatics who struggle making the decision, the tips provided here should help you.