What happens to asthmatics in the ER?

The following post was originally published at healthcentral.com/asthma on 12/6/11

Asthmatics: Here's what to expect in the ER

There may come a time in the course of your life that you may need to take your asthmatic lungs to the emergency room. Many of us have experienced this already. So what's it like? What happens to us asthmatics in the emergeny room?

I've experienced this both as the patient and as a therapist. I've written about my experience wavering whether or not to go to the ER, and I've written about my experience taking care of asthmatics. So now it's time for a little more detail.

Here is what might happen in the ER.:

1. Fast pass: Come in with the chief complaint of shortness of breath and you will get a fast pass to the front of the line.

2. Respect: You will be treated with utmost respect. No one will lecture you becasue you're not short of breath enough. In fact, if you come in before your asthma gets too bad we willrespect you all the more.

3. Breathing treatment: By the time you get to your room and slip on a gown your friendly respiratory therapist should already be on his way. As soon as he arrives you'll be given a breathing treatment of either Albuterol (Ventolin) or Levalbuterol (Xopenex).

For many of you this may be all you need to catch your breath. Yet for others, more therapy may be required.

4. Subsequent breathing treatments: Chances are if you've already used your rescue medicine at home, more than one breathing treatment may be required. You may be jittery as a jackhammer by the time they're finished with you, but it will be worth it because you'll have your breath back.

4. Systemic Corticosteroids: Systemic steroids may be given as early as possible to help reduce the inflammation (swelling). These may be given by IV route, or intramuscularly (shoulder or butt). It may take an hour or more for this medicine to start working, so bronchodilators can be used liberally in the meantime if needed.

5. Sputum sample: If you can, a sample of your sputum should be obtained and sent to the laboratory to test for an infection in your lungs and the best antibiotic to kill it.

6. Lab draws: Lab may also draw your venous blood to test for signs of infection or other indicators that show what might be the cause of your trouble. This may not be indicated if all you needed was one or two breathing treatments and are discharged.

7. X-Ray: This is generally done for two reasons. One, it can rule out other causes to your problem, such as pneumonia. Two, it can show how bad your asthma attack is. After a while an asthma attack may cause your lungs to hold extra air (air-trapping), and this can show up on the x-ray as hyper-inflation. Air trapping may also cause you to have a barrel chest, or a wider chest as a result of too much air in your lungs.

8. Oxygen: For mild asthma attacks it is rare for your body to have trouble taking in oxygen. In fact, in the early states of an acute asthma attack, your oxygen intake may actually be increased as you breathe faster.

However, if you wait too long to seek help, or if you have severe asthma, your body might tire from working so hard to breathe for so long. When this happens your lungs ability to oxygenate your body may become impaired, and supplemental oxygen may be needed.

9. Pulse-oximeter: This is a little probe that is placed on your finger to monitor your oxygen. It's actually called the 5th vital sign after heart rate, respiratory rate, blood pressure and temperature. A normal pulse oximeter is 98%. This means that 98% of hemoglobin in your red blood cells are carrying an oxygen molecule. As your body starts to poop out this may start to drop. Once it gets under 92% you will probably be placed on supplemental oxygen.

10. Peak flows: Occasionally we will have you blow in a peak flow meter so we can monitor your progress. Read more by clicking here.

What happens from here depends on your lungs:

A. Discharge: Most of the time your asthma attack will be reversed quickly and you'll get to go home. The following will determine if this occurs:

• You don't need too many treatments to turn you around
• Your oxygen saturation stays above 92% without the need for oxygen
• Your Peak flow numbers are returned to normal or near normal
• You are able to breathe better
• You have ability to take medicines at home.
• You are a Gallant Asthmatic
• You and your doctor feel comfortable with you going home

B. Admitted: Sometimes it may take more time to get you feeling better. This happens much less often today as in the past (as I wrote here), although some asthmatics still need to be admitted from time to time.

Things that make it easier to fix you:

• You're a gallant asthmatic
• You follow your asthma action plan
• You didn't wait too long to come in
• The severity of your asthma
• The severity of your attack
• It's just asthma (nothing else complicating things)
• Luck. This always helps. 

You must consider that every asthmatic is unique, and putting the right potion of things to fix you may be a matter of trial and error.

Hopefully you'll never need the services of an emergency room, yet if you do, now you know what to expect. If you need tips on when to go to the ER click here.
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