Sometimes, I amaze myself at how stupid I can be. I mean, I treat people for asthma often enough, that as an asthmatic myself, I should know better about getting help when I need it. But nooooo... I, like many other EMTs and paramedics, think that we know enough to take care of ourselves when we get sick or hurt. It is an arrogant trait, one that we really shouldn't have.
On May 17th, I had an asthma attack while returning from an EMS assignment. We had gone through a big dust cloud that was created by an RV in front of us while driving down a dirt road on a mountain. I wasn't affected initially. In fact, earlier in the day, I used my albuterol preventatively due to the heat and dust that was being created from the mountain bike race I was providing EMS services at.
On a scale of mild to severe, this was a moderate asthma attack. Enough to make me cough like hell (a hallmark of my particular asthma), to wheeze, to have more problems breathing out than in (a hallmark of all asthma), and to eventually impact my ability to think clearly. It started out innocently enough. I just had a mild cough, that started about an hour and a half after the dirt road. I even joked to the EMT with me about it. Soon enough, I realized I needed to use my albuterol inhaler. I had it in my pocket; I reached in to grab it, and realized that the outer plastic case was missing. All I had in my pocket was the medication canister. Not good. But, I do keep a spare with me. The other EMT went into the back and grabbed it for me. No problem. Two puffs, and all would be good.
Except it didn't work. I took two more puffs... and two more... and two more, over the course of the next half hour or so. By the way, I was driving. The EMT with me wasn't cleared to drive the ambulance. But, I was in control, and although I was coughing a helluva lot, I was still able to breathe ok. And drive safely. We even kind of joked about it over the air.
I continued to use the inhaler (I use an inhaler with a spacer, which generally provides the same effect as a nebulizer treatment), without any success. We eventually stopped for a bathroom break, and I stayed in the ambulance. I just couldn't get out. I had no energy, and was rapidly getting short of breath. I knew I couldn't drive safely any further. So, another EMT took over driving the ambulance, while I went and became a passenger in the Jeep. This would let me concentrate on treating myself. I headed over to the Jeep, and suddenly a wave of nausea overcame me. I knew I didn't want to puke all over the Jeep, so I quickly went to the front of the Jeep, and stood in a planter area. I didn't think I had actually thrown up, but I since found out I had. My legs were like rubber, and I had to steady them with my arms extended just to stay standing. Eventually, I got into the Jeep. The EMT driving tried to get me on some O2, but I declined (stupid!). I figured I would improve (Big hint I wasn't thinking clearly... I know the progression of breathing disorders, and I was heading into big trouble.). I kept sucking on my inhaler, sipping water, and probably going in and out of consciousness. My vision tunneled, and I eventually couldn't see much. I don't remember much of what the other EMT was saying to me. I think I remember her talking on the radio to the ambulance.
Within 20 minutes, we were at the first stopping point in Sacramento, to pick up my Jeep that had been used at another event. Clearly, I still couldn't drive. But I was so short of breath that I finally said yes to some oxygen. 10 liters per minute via a non-rebreather mask. My vision came back pretty quickly. I managed to pull out my pulse ox meter (measures how well tissues are getting oxygenated - 96-100% is normal) from my fanny pack, and put it on. 84% initially. Eek. Even not thinking clearly, I knew what that meant. The numbers began to come up quickly while on the oxygen, but I had decompensated. My pulse ox stays high and then nose dives when my asthma gets bad. I know at some point, someone mentioned my going to the E.R., but I said no. I wasn't getting worse at that point. This is arrogance. Adults have a right to be stupid. Even EMTs. I should have gone.
Which is exactly what had happened. The oxygen began to make a difference. I started to breathe a bit better, allowing more oxygen into tissues, but keeping a proper mix of carbon dioxide in the body as well. "Blowing off CO2", as many of us in EMS call it, is seen frequently in people who hyperventilate. Many times, they fall unconscious due to blowing off CO2, which slows their breathing, corrects the imbalance, and wake back up. Mine was probably a combination of hypoxia and hyperventilation, since I couldn't breathe deeply, I was breathing rapidly.
The albuterol began to FINALLY open up my airways. And I started feeling better. We made it back, and all of us eventally went home (I was at home at that point, as we all met at my place to go to the events that weekend). I continued to use my albuterol that night, but the worst was clearly over. I did take a long shower to make sure I didn't have anything on my skin that would create further irritation to my lungs.
Should I have gone to an E.R.? YES. Should I have followed up with my allergist the next day? DAMN RIGHT. Did I? NO.Is this an excuse for others with asthma to avoid the E.R. NO WAY! What I did was stupid in not wanting the oxygen or the E.R. trip, pure and simple.
This story should have ended here, but it doesn't.
My lungs have remained "twitchy" since that wonderful day. But, arrogant as I am, I can handle that... I was using my albuterol a couple times a day, but it was "under control". Right. NOT. I refilled my meds, so that I had a full supply with me, and went on a trip to NYC that was planned. It was work-related, and I needed to go. I was given a piece of paper that I had not been previously given by the pharmacy, which mentioned the need to "prime" the new HFA Pro-Air inhaler that was my albuterol inhaler. Especially if it isn't used for 2 weeks. Well, up until May 17th, I had not used my inhaler for at least a month and a half. If it isn't primed, then the albuterol isn't delivered. Hmmm... thinking back on it, this may have contributed to my asthma attack. I made a decision to re-prime my inhaler weekly from then on.
I did ok most of the time out in New York City. Used my inhaler a few times each day, but stayed fairly clear. Did my work out there, and had a lot of fun in the evenings. Coming back, the last dose I needed was earlier in the day, and I didn't use any until mid-day after I got back.
This weekend, I worked EMS as usual. Saturday was in one location, Sunday in another. Twitchy lungs and all, I went out. Both locations were dusty, and I needed more albuterol on Saturday. Got home, showered, felt better, went to sleep, got up, and went to the Sunday event. Dusty and windy there, too. I took a more preventative approach that morning. I used my inhaler before I had any problems.
Well, the problems still happened. I managed to get through the day, even taking care of a patient and transferring him to EMS transport when I was feeling pretty bleh myself. On the drive back, I needed to use the albuterol more and more again. Not as bad as the 17th, but I even commented that I HAD to get in and see my doc to get this under control.
I got in to see him today, thankfully. I am grateful to his nurse who worked me into what must be a very busy schedule for this allergist. His next available appointment for routine care is August. After spirometry, which looked pretty good (I had used my albuterol two hours earlier, before I got the appointment), and a peak flow test (470 out of a norm of 550 to 600 for me), it was obvious that I needed some medication tweaking. He upped the daily inhaled steroid I use (Advair, for those of you who follow asthma meds... it is a combination of an inhaled steroid, and a longer acting version of albuterol called salmeterol to basically keep the airways as open as possible) to the max dose for the next month or two, prednisone if I felt I needed it (I do, and I did start it), more judicious use of my albuterol via inhaler and spacer or by nebulizer, and some blood work to see if we can spot the culprit, since clearly I am having issues when it is dusty and windy. Probably a mold floating in the dust. I will find out soon.
In the meantime, I am taking it easy at least today. Resting, taking my meds, and staying hydrated. I don't know if I am going into work tomorrow or not, until tomorrow. If I am still coughing and as damn tired as I am just sitting here typing while on my bed, I will take another day to get better. I HAVE to get this under control. I certainly don't want to end up in the E.R. fighting to breathe (or getting intubated... been there, done that). My work needs me for my day job, and my business needs me for EMS. And I need to be a better example to my patients.
I need to learn to be a patient patient myself. And to not be stupid.
p.s. Read
http://urbanparamedic.blogspot.com/2009/06/heal-thyself.html (I'm not the only one who is guilty of this transgression. This paramedic was truly lucky.)
Labels: asthma, EMS, Misc Rants
Today, I got back on my bike. This is the first time since the crash on May 5th that I have ridden. I missed it so much! I didn't get to just ride. I was actually working EMS at a race in Folsom tonight, the Running of the Bullipedes. So, I loaded up the panniers with the EMS gear (An AED, diagnostic tools, cervical collars, airway management items, wound care, splints, slings, water, and more... Yeah, it all fits!), hooked them on the rack (which I had to re-install last night), strapped the oxygen tank onto the top of the rack, put on my NEW helmet (Yes, I did retire my old one after the crash), and followed the racers on the mini-marathon (1 mile) through historic Folsom. I stayed behind the racers for most of it, talking with one of the Folsom PD motorcycle officers that was also following the racers. He was really nice to talk to.
