How is Asthma treated in the ER? UPDATE--Back from the ER

[lovetoscrap]

Yeah, sort of looking for medical advice on a discussion board. But I am doing okay right now. Just looking to be prepared.

I am having my 3rd asthma flare up in the last few weeks. I have been to the ER with DD when she was younger and having an attack and it was a colossial waste of time and money. They gave her a neb treatment (exactly the same as I was doing at home) and left us alone--totally alone, no one checked on us, no monitoring of any type-- for hours. At one point a respiratory therapist come in with the same type of Peak Flow meter I had brought with me, she had DD breathe into it twice and left. We were charged over $400 for that. After some more neb meds she was doing better and I was fed up so we left. We could have stayed home and kept her on the neb ourselves and saved a lot trouble.

And the same has happened when I have gone to the Urgent care for myself. They just put me on the Neb and leave me on it until I am doing better and send me home with a script for steroids (which I already have anyway).

SO, what is the point of going to the ER? Last night I was in bad shape. I had told myself if after 6 treatments I wasn't better I would go. After 5 I got enough relief to get a little sleep. And then several more a few hours later repeated most of the day today. My doctor hasn't really told me when I should be worried and go, just "if you don't think the meds are working"-- but if they are going to give me the same stuff why bother?

 

[princess momma]

You'll probably get an albuterol neb.

The thing is, you never know when the attack will cross over into life threatening territory. So go in if you can't control it at home.

 

[nrsldy]

Our standard treatment is an atrovent and albuterol neb tx, IV steroids and oxygen. If wheezing and decreased air movement persists after 2-3 treatments admission would be considered. If you have to give yourself 5-6 treatments for relief that is not good. If that continues you need to be seen.
I hope you start to feel better.

 

[C.Ann]

You'll probably get an albuterol neb.

The thing is, you never know when the attack will cross over into life threatening territory. So go in if you can't control it at home.

Our standard treatment is an atrovent and albuterol neb tx, IV steroids and oxygen. If wheezing and decreased air movement persists after 2-3 treatments admission would be considered. If you have to give yourself 5-6 treatments for relief that is not good. If that continues you need to be seen.
I hope you start to feel better.

I agree with both of these posts.. It's such a tricky thing.. You can go from having "difficulty" to not being able to breathe AT ALL in the blink of an eye..

I'm thinking you might best go and get checked out..

Good luck!

 

[K and K's Mommy]

We haven't been to the ER with my DS 10 since he was 3. He ended up being admitted because his oxygen levels were too low. They told me then that if he needed his albuterol more than every 3 hours I should come to the ER or doctor's office.

My DS's asthma is pretty controlled now. As long as he has his Flovent at night, we don' t have any flare-ups. The couple of times we've gone off it, we're right back at the doctors needing prednisone. I think that is what it is. It's actually been a couple of years since we've had to use the more powerful steroids.

Good luck!

 

[golfgal]

I would go to your asthma dr and see what is up. Maybe you need to adjust your maintenance meds???

We have only been to the ER for one asthma flare up. DS14 had an attack in the middle of the night we thought was croup. It didn't respond to steam or cool night air, took him into the ER they did 2 nebs and put him on oxygen. He didn't improve so they admitted him to the hospital. He was on oxygen and I don't remember what else. He stayed until 5 PM the following day and went home on nebs and prednesone (I think). It was a few years ago.

I can't imagine how fast your heart was beating with 5 neb treatments .

 

[angeluna]

IV steroids have become one of the most reliable and quick rescue treatments. They will give you more nebs of course, too. But, you do need to get checked out. Asthma can turn quickly. You should, if not already, be on a maintenance inhaler. These prevent attacks from happening. If you have these episodes at a predictable time of year, maybe allergy medicine would benefit you too. Good luck. It's always better to be safe with your health.

 

[kilee]

Like others said it can change quickly, so I defintely would talk to your doctor about at which point they want you to go to the ER.

I guess the good thing is if they mostly left you alone, then you were very stable and that is actually great.

I know I often feel as though I'm going into an exacerbation, but I'm truly not.....if that makes sense. The minute I start to feel that chest tightness I start to panic and usually go to the doctors for a breathing treatment and a shot.

I know ironically I went to the ER overnight last night because I felt like I was having trouble getting a deep breath. I also have flu symptoms and I think I was panicing a little because you hear of that small percent that get pneumonia quickly.

Anyhow what felt like impending asthma attack to me.....wasn't. My pulse ox was perfect @ 100--- I blew over 550 on the peak flow and my chest xray was crystal clear. (Not to mention I'm already on Prednisone, Tamiflu, Z-pack, and Flovent to try and control my asthma during this virus-- oh and on Friday I got a shot of Kenalog too). They said my lungs sounded perfect and not even congested....so that asked me what else they could do for me. I said nothing and kind of felt foolish, but ultimately I didn't care. I felt like an attack was coming on and I wanted to be safe.

 

[lovetoscrap]

I am on regular allergy meds and have been for years and the asthma usually only flares up once or twice a year. This is the longest it has every lasted. Currently I see my regular dr and not an allergist--my dr did recommend I get back to one. I only have an albuterol rescue inhaler and nebulizer with albuterol since I rarely have problems, they have never seen a need for anything preventive.

I guess I am really just stupid. I often think the next day that I probably should have gone, but then I say "well, I ended up just fine without going". Hopefully things will be okay tonight. But if I get to feeling like I did last night I guess I will go.

 

[Aimeedyan]

I have always received fantastic care in the ER, but after dealing with my asthma since a small child (and my mom doing the panic and race to the ER when it wasn't necessary too many times), I know my ER worthy signs and truly AM in need of emergency care when I get there. I've never waited in the waiting room, matter of fact, or been left alone more than a few minutes while doing the neb (of course not to say you weren't in need of emergency care, just that I know some aren't - my mother is case in point )

It's been years since my last visit, my asthma is more under control now than it's ever been. Medication has come a LONG way plus I have a nebulizer, which no one had when I was a child. When I was a kid and had an attack the rescue inhaler couldn't touch, I went to the ER for even just a nebulizer treatment. What a waste of an ER visit! Thankfully those are fairly standard in homes now.

I have only been admitted once - they did 7 albuterol treatments by neb in the ER and it just wasn't doing the trick (I was turning blue) so into the ICU unit I went. Spent 2 days there before they moved me to a regular room. I was in high school.

I'm sorry you haven't received care like you should have. Asthma really is more dangerous than a lot of people think and can turn quickly. The last time I was in the ER was as a college student, we went to a movie theater/restaurant that still allowed smoking. Something there triggered it and by the time the movie ended, I could barely stand up. My then boyfriend (now DH) literally carried me to the car and raced to the ER where he carried me in and they took me right back. It is still unreal that my breathing went from fine to nothing in less than 2 hours.

 

[CowboyCO]

I am on regular allergy meds and have been for years and the asthma usually only flares up once or twice a year. This is the longest it has every lasted. Currently I see my regular dr and not an allergist--my dr did recommend I get back to one. I only have an albuterol rescue inhaler and nebulizer with albuterol since I rarely have problems, they have never seen a need for anything preventive.

I guess I am really just stupid. I often think the next day that I probably should have gone, but then I say "well, I ended up just fine without going". Hopefully things will be okay tonight. But if I get to feeling like I did last night I guess I will go.

If I were you, I'd be talking to your regulat FP about maintenance meds. If you are this bad, this isn't a simple allergy thing. It may be based in allergies, but if you've got a nebulizer at home, it amazes me they don't have you on some type of regular inhalant such as Flovent or Advair. Things can go from bad to dead very quickly with asthma, so the trip to the ER is never worthless. They help you get it under control and if it gets bad, there are more things they can do for you. Good luck! My DW has asthma and it can be very tricky.

 

[lovetoscrap]

I know my ER worthy signs and truly AM in need of emergency care when I get there. I've never waited in the waiting room, matter of fact, or been left alone more than a few minutes while doing the neb (of course not to say you weren't in need of emergency care, just that I know some aren't - my mother is case in point )

.

So how do you know? What are the signs?

 

[Aimeedyan]

So how do you know? What are the signs?

It's been years (10, actually!) since my last ER visit but if I get to that point where I am desperately sucking on the rescue inhaler with no relief, I head to the ER. You know where you are sitting on the edge of your chair with your back straight up and down trying to grasp for breath, and your back is killing you from the pain of laboring? It's beyond wheezing. You can't even speak. I head to the ER, they take me straight back.

Now, a nurse or doctor may come on and tell me I've waited too long at that point BUT I try desperately to solve things at home first. ER visits are pricey, and you end up waiting awhile if things aren't "dire." Call me lazy and cheap There have been times when 2 puffs on the albuterol and a couple Neb treatments solved things at home. (I will say I live less than 5 mins from an ER)

Hope that makes sense

Seriously - Advair has changed my breathing. It's amazing and the only asthma med that has truly kept me ER free for years on end. Talk to your PCP or an asthma/allergy specialist abt a maintenance drug like Advair.

 

[KeeperOfTheCastle]

I also have asthma. I had my peak flow measured at the Dr. office when I was feeling fine. He then let me know of the peak flow readings I should be concerned about. At one level I should call his office, and at the other one I should go to the emergency room. I am on maintainence meds and have not had to go to the ER once since I became a patient of this Dr, which is about 9 years. I do have to call his office once or twice a yr when I have a flair up, usually if I get a cold.
Hope you are feeling better soon.

 

[Aimeedyan]

I also have asthma. I had my peak flow measured at the Dr. office when I was feeling fine. He then let me know of the peak flow readings I should be concerned about. At one level I should call his office, and at the other one I should go to the emergency room. I am on maintainence meds and have not had to go to the ER once since I became a patient of this Dr, which is about 9 years. I do have to call his office once or twice a yr when I have a flair up, usually if I get a cold.
Hope you are feeling better soon.

Oooh, I forgot about the peak flow meter! I wonder where mine is I haven't needed to use it in so long. That's a great suggestion! My doctor (years ago) did the same for me and it does help show you how you really are doing.

 

[lovetoscrap]

Okay, I am considering maybe going if things get any worse tonight. And DH is going to have his fingers on 911 all night!

I have been nebing every few hours (am on it right now) with at least 2 treatments each time to get relief.. I am coughing up mucas but also vomiting when I cough(sorry if that is TMI) Chest is tight, of course it really hurts from the last 24 hours of problems. I don't usually wheeze and don't think I am now, but I just can't "catch my breath". Last night was the first time I remember really feeling like I was suffocating. I haven't checked my peak flow, the meter is upstairs and I am not going up the stairs now. fingernails and lips are normal-- no blue.

 

[quentina]

Last time I got the albuterol nebulizer treatment and a cat scan of the lungs (this is the reason to go to ER), just to make sure all is OK.

 

[Tinker'n'Fun]

I think it's time to pack up and visit the ER or Immediate Care if yours are still open. Feel better and update, okay!

 

[angeluna]

I think it's time to go also. Probably should have already been. Not preaching, just worried. I am a Respiratory Therapist, as well as having 2 children with asthma, so I deal with this everyday. Care Now (urgent care center) is sometimes a good option. They can give you steroids at least. Keep us informed. Sorry you're feeling bad.

 

[KeeperOfTheCastle]

I do agree that it is time to go to the ER. Asthma is nothing to fool with. I don't want to scare you, however people do die of asthma. Please get well soon!