i think when im in hospital my brain has too much time to think, there a load of short questions running round my brain, wondered if you guys knew (feel free to add your own questions!)
when they feel your chest, on the left side, in line with the bottom of your sternum for something to do with your heart, what are they feeling for?
what do they look at your hands on chest wards for?
why is humidified oxygen 'more' than the regular stuff?
how do they do a bone density scan?
is bone loss from pred reversible?
is lung pain ever a sign of a chest infection (i have mentioned this - dont worry!)
does wheeziness through a stethoscope sound the same as it does when you can hear your own lungs?
how does pulse oximetry work and why does it sometimes get HR ridiculously high (incorrectly)
has anyone found that pain or suddenly being very stressed improves their breathing (i wondered if it was something to do with adrenaline?)
im sure i'll come up with more, these are just the kinds of things that are nice to know but dont tend to be a priorty when talking to doctors thought you guys probably know as much as most docs anyway!
19 Replies
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I think:
When docs feel your chest possibly they are looking for an enlarged heart as with chest infection sometimes fluid builds up around lungs and then heart...
They look at your hands to see if you have blue/grey nails this is called cyanosis (sp?) and is a sign of serious lack of oxygen. Your body will stop oxygen flow to non important places like extremities to reserve more for vital organs.
Humidified oxygen is better for you as normal can dry out air passages and this can further irritate lungs etc
pulse ox i believe works by tracking minute changes in colour or heat of the finger.
Sorry i cant answer the other questions but would be interesting to hear others answers
Rose xx
I don't have much to say on most of your questions but lung pain(I assume its lung) is one of my first symptoms of chest infections, I usually get it before I start running a temperature, coughing stuff up, etc.
When they feel your chest they are feeling for the apex beat of the heart to see if its in the right place. Can move if your heart is enlarged which could be due to numerous causes.
Hands give lost of clues as to diseases/how your doing. One such thing they're looking for is cyanosis but lot of other signs can be seen on the hands.
Humidified oxygen isn't more oxygen but it doesn't irritate airways as much. Usually people can tolerate non-humidified up to 35/40% then they get switched over but you can give humidified at any percent.
Bone density scan is done with a special decade scanner ... Basically you just lie there!
Bone loss isn't reversible but by taking bisphosphonate s and calcium supplements it can be stopped/slow down.
Lung pain can be a sign of infection if the infection is irritating the pleura (lining of the lung) ... You can usually tell if its a sharp pain on breathing. Lung pain can also be muscle strain from breathing/coughing when struggling.
Wheeziness doesn't always sound the same down a stethoscope ... You should ask if you can listen to your own lungs!
Pulse oximetry works by measuring the amount of oxygenated haemaglobin by comparing the infra red signal from blood flow through your finger. (Sorry pretty lame explanation ... Easier with a graph!) it measures pulse as it detects the arterial blood flowing with your heart rate. It's sensitive to artefact so if your moving (ie salbutamol shakes) it can give a falsely high reading.
Don't know about stress/pain improving breathing, sorry.
Sorry, DEXA scanner ... Not decade silly predictive!
hehe I also wonder about this kind of thing. I may actually know the answer to some given I now have a housemate who is a junior doctor and imparts his 'wisdom' which I sometimes want to hear and sometimes don't (at other times he comes out with classics like 'what part are the balls of my feet?' and 'my tibulas are fine'. lol) EDIT just realised an actual medic has answered who will know way more, but oh well, I had fun!
i think when im in hospital my brain has too much time to think, there a load of short questions running round my brain, wondered if you guys knew (feel free to add your own questions!)
when they feel your chest, on the left side, in line with the bottom of your sternum for something to do with your heart, what are they feeling for?
I am not 100% sure but I think this is the apical beat of the heart. Which I always thought was, you know, at the TOP of the chest because apex means top but my housemate informed me is not, it's at the bottom. Anatomists are an odd lot, there is a reason but I've forgotten.
what do they look at your hands on chest wards for?
Umm, I think - reperfusion is one ie if they press your nail down how quickly does the blood come back in? Also I think the angle of your nails somehow imparts info about lungs - something to do with nail bed swelling maybe? This is all secondhand, I prefer brains. EDIT just seen others' answers, forgot about the cyanosis!
why is humidified oxygen 'more' than the regular stuff?
I don't know but I'm sure most on here hope so! That is something you can reasonably ask about though when you get the results.
is lung pain ever a sign of a chest infection (i have mentioned this - dont worry!)
Seems like it could be but I don't really know.
does wheeziness through a stethoscope sound the same as it does when you can hear your own lungs?
My housemate has borrowed my speakers to practise listening to lung sounds etc online so oddly enough I do know what a wheeze sounds like 'up close' despite never having had the urge to listen to people's chests! There is apparently a difference between monophonic (more restriction, according to my source after hearing me cough wheezily) and polyphonic, but I am not sure of the fine details. To me, the version through a stethoscope/speakers sounds rather a lot louder - as you'd expect - and rather like what you'd hear if you played a whalesong tape very loudly on a steam train (the 'steam train beat' is your heart).
how does pulse oximetry work and why does it sometimes get HR ridiculously high (incorrectly)
en.wikipedia.org/wiki/Pulse... - it measures and compares the absorbance of the different light wavelengths. v interesting as on my course we were learning about how you can use a similar technique for brain function in infants.
haha I thought I was the only one who had that effect on monitors! My physio once got some ridiculously high readings (250s) and was checking the machine and saying 'if this is right we're going to cardiology NOW but I don't think it is'. It wasn't of course - she just felt my pulse in the end and said 'nope, that's ok, it's only about 120). Last time on the treadmill, she said 'well, my monitor and the treadmill do agree now so maybe this is right...'
has anyone found that pain or suddenly being very stressed improves their breathing (i wondered if it was something to do with adrenaline?)
Not sure really but the adrenaline thing might make sense - though I know stress can be an asthma trigger! It was for my uncle and they gave him adrenaline for attacks as a kid apparently.
im sure i'll come up with more, these are just the kinds of things that are nice to know but dont tend to be a priorty when talking to doctors thought you guys probably know as much as most docs anyway!
Hehe I don't think I know that much but I am the same, I like to know but don't like to ask and take up their time, plus I worry they'll think I'm being really anxious when I'm actually just curious.
the thing where they felt my chest was two 2nd year medical students, they felt a 'tapping' and both seemed very surprised as i wasnt a heart patient.....always worrying!
you guys are all doing very well with my questions thanks!
philomena-im like you, im really interested in how it all works, and as i frueqently get palpitations, im always curious as to what my HR actually is, but they always think youre worried or obsessing if you ask! once had someone refuse to tell me so i took my own (150!!! so actually i had a good reason to ask why i was feeling a bit strange!)
i actually might be able to steal my mums stethoscope, i have a very luoud wheeze so it mght be hard to work out where the sound is coming from!
i quite often have a HR of 250 according to pulse ox, can usually switch fingers for a while and find one i believe, nurses rarely do and take it manually, i tend to be tachy around 130 when my lugs feel cross but they never expect that!
i doubt the linngs of my lungs are infected, i think id know about it if they were,its jst such a sharp deep pain that i didnt think it could be muscles in my ribs, and it doesnt feel like myusual tight kind of pain. hmmmm...
when youre having lots of nebs and using nasal canulas on and off is there much you can do about nosebleeds?
edit:forgot to ask, is there a reason i feel so hideously sick all the time when my asthma is bad...or is it just hospital food lol!
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philomena-im like you, im really interested in how it all works, and as i frueqently get palpitations, im always curious as to what my HR actually is, but they always think youre worried or obsessing if you ask! once had someone refuse to tell me so i took my own (150!!! so actually i had a good reason to ask why i was feeling a bit strange!)
Me too - always curious. I know I need to listen to my body, but I like numbers that back it up. Doctors don't have a monopoly on wanting to play subjective and objective information off of each other to understand the whole picture.
I think it is great that you ask so many questions.
I was actually a bit annoyed once because I discovered from reading various notes/letters that I'd finally been given copies of that they had actually noticed my tachy/ectopic beats when I wasn't sure if they'd picked up on them, because they just said 'you're fine'.
I was once told ""all clear, no wheezing"" but when I looked at the notes he wrote, it said 'diffuse wheezing'.
Sometimes I wonder if there is an element of psychology involved here.
Doctor was nice enough and clearly taking me seriously, so the only explanation I could come up with was that my self report (SOB due to asthma) and what he could see (high heart rate; minimal wheezing) didn't quite match up. He was trying to decide whether to go by my self-report or the signs he could verify himself. So either (a) he didn't want to muddy the waters of my subjective self-report with his own observations. (b) he was deliberately feeding misinformation in order to see if I stood by my symptom report even in the face of counter evidence.
In the end he seemed to compromise: he gave me an EKG to rule out a heart issue and then a neb once he was sure it was my lungs and not my heart causing SOB.
edit:forgot to ask, is there a reason i feel so hideously sick all the time when my asthma is bad...or is it just hospital food lol!
I vote for hospital food. Hope you are getting some yummy stuff from friends while you are captured.
I'd love to be able to listen to my lungs, maybe I should ask if I can next time, especially when they say ""oo, sounds like rice crispies"" lol.
hehe I don't think I'm flexible enough - would need some help there! I was kind of annoyed with myself for not asking what my GP heard this week as I think I might, for once, actually have had a wheeze that someone heard and it would have been good to know. Normally he tells me when it's clear but this time he just went 'hmmmm', looked kind of thoughtful and started debating higher pred doses. Possibly I scared him if I did have a wheeze lol as I've staggered into his office before in a bit of a state and not had one so he might have been wondering what was going on.
My friend's husband is a grad entry medical student and she said when he got his stethoscope they had fun playing with it, but since neither of them at that point really knew how to use it they didn't actually hear much - she said she was a bit worried he was dead because she couldn't hear a heartbeat at all!
defo agree Soph that they tend to think you're worried etc. I guess with some people it might be that but I wish they'd credit that some of us might be scientifically curious and not ALWAYS just worried - curious people get ill too! I was actually a bit annoyed once because I discovered from reading various notes/letters that I'd finally been given copies of that they had actually noticed my tachy/ectopic beats when I wasn't sure if they'd picked up on them, because they just said 'you're fine'. I was actually much more reassured once I knew they'd noted them but they weren't a problem than when they were just saying 'it's fine' because I could feel it wasn't quite normal all the time, I just didn't know whether or not it was really a problem and them saying 'well we noted this but it's totally benign' would actually have been much better.
I appreciated it much more when I had a cons who seemed to think I was another of his students and would give me mini-lessons on inflammatory cycles and how to read a CT, plus tell me exactly why he was ordering a certain test or what his reasoning was.
From my experience
- the position of your heart in your chest can be shifted by fluid build up and under certain types of heart failure pulses can be felt through the chest abnormally. Dr have to check asthma attacks are really that as cardiac asthma can sound extremely similar in presentation.
- Hand checking for chest patients can show blue fingers for low oxygen levels, skin quality can show hydration levels and whether you need help with IV fluids, clubbed nails can also indicate that low oxygen levels have been happening long term ( more for heart or COPD than 'normal' asthma). Nails can also show up vitamin deficiencies and anemias that can make you breathless. Hands can also show signs of swelling which may be caused by heart, infections, long term steroids, embolisms and a heap of other reasons. Tremors can also be checked as usually down to inhalers and Nebs for asthma patients
- pulse oximeters are heavily affected by salbutamol shakes but can also give odd readings if you have things like ectopic beats or heart rhythm abnormalities. Drs like to keep a check on these because some of our meds can have these types of side effects eg aminophylline. Sometimes other factors can affect your asthma such as heart problems (mine were only found when having checks after odd readings for asthma ). Manual readings usually sort things out though!
-humidified oxygen prevents your lungs from drying out and being further irritated. Usually given when you need larger amounts over a long period of time. Whether you get it also depends on which ward or unit you're on IMHO!
new thoughts: my mouth, tongue and throat are sooo sore at the moment. I had 9 nebs back to back in A&E the other night, and then had an oxygen mask on all night, so i guess that could be somthing to do with it. But i thought thrush made the inside of your mouth all white, and its not. my tongue looks all red and scratched. Im also having a really hard time swallowing, my throat feels swollen (not allergic reaction type swollen - dont worry!) I was wondering if it could be reflux from the pred, i eat with it, but i know that doesnt always help. Think im gonna go back to the GP if its still bad in the morning, but wondering if anyone else has had this or has any ideas. Also what do people do with regards to looking after their mouths when they're in A&E or that first night in hosp when i still find im being given a zillion nebs and cant really walk around much (to brush teeth etc!) any tips?
does anyone else ever have IV cyclizine and find that it makes them kinda get vertigo? the doc the other night mentioned another IV drug she gave - has anyone else tried summit that worked better (it'd have to be IV, im fine with the tablets but i cant take them when im in A&E)
does anyone else take food into hospital - i really hate hospita food - i usually grab a couple of cuppa soups, do you have any more tips? something small and can be made with hot water or eaten cold?
does anyone know how much evidence there is for magnesium? I aways find it really helps, usually within sort of 30mins, but my consultant says theres not any evidence for it? do you guys find it helps?
Hey soph...
Not much to add from what all these other wonderful people have said other than (as i dont seem to have read it) and that is with your hands docs can also look for tremors for how medication is effecting u. And another one with your hands is they get you to hold your arms out in front of you and point your hands to the ceiling. This is to test for a different type of tremor or flap. As if you are retaining your carbon dioxide you will have a steady flap in your fingers ans hands where as if you are blowing it off (basically hyperventilating) you will have a very quick flap/tremor. I learnt this when I helped my consultant out with 5 med students. When I was poorly once. She taught both then and me.
Sorry if it doesnt make sense
Xxx
Not sure I can help with most of this but just some thoughts re magnesium...
I am no expert but surely, since other medications work for some asthmatics but not others (eg they found some people (study done on children but presumably also applies to adults) have a genetic mutation that changes receptor shapes, meaning that Serevent doesn't work for them because it can't fit but montelukast probably will), then perhaps magnesium works for some but not others? I have never been in A&E so not been given it but would have thought this might still apply. Being a geek though I was curious and looked it up on Google scholar: scholar.google.co.uk/schola... - thought as you're a numbers/science type you might be interested too.
Some of these say it makes no difference, but some say it doesn't always help and probably won't for moderate exacerbations, but can help and should at least be considered in severe exacerbations (I looked at some meta-analysis results). As you know I'm not a doctor or any kind of expert, just looking to see what's out there. Perhaps you could point your consultant towards these if he starts up again about how there's no evidence, though I guess he might be thinking of other stuff I don't know about. It doesn't seem to be as clear cut as he's suggesting though (well, if there were absolutely no evidence that it ever works why would it even be used at all?)
Hope your mouth starts feeling better - horrible feeling, I used to take a medication (not for asthma) that made my mouth sore and it was nasty. Perhaps ice cream would numb it?
New thoughts: how high is a white cell count of 15?
When pred says it can 'reduce signs of infection' does that lower white count, or reduce symptoms like temperature or cough?
Does asthma cause reflux as well as reflux causing asthma?
Why are hand cannulas soooo painful?
Thanks guys
A normal white cell count is 4,300-10,800 (or 4.3-10.8)
A mild to moderate count is 11-17, so 15 you asked about would fall into this category.
Taking prednisolone can increase your WBC and the higher dose/longer time on it increases it more, in some cases to 20,000.It can also mask signs of infection and hinder your bodies natural immune response to fight infections.
This is what I understand anyway but I'm not a medic, so someone more in the know may help you understand it better than I can!!
Yes, reflux can aggrevate your asthma symptoms and also asthma can upset your reflux so sometimes its a bit of vicious circle getting the two to behave and live together quietly!!
I thought pred would decrease white count - coz it reduces your ability to fight infections? how does it do that if not by affecting WBC count? it explains why my registrar thought it wasnt worth taking the antiBs then! so thanks! and stupid asthma/reflux viscious cycles - thats not fair!!!
more random musings from my brain when bored in A&E...
when gloves say powder free, why is this, i assume either some are powder, or they all used to be? cant see why powder-y gloves would be useful, or is it a cost thing?
What size order do cannulas go in (so is pink bigger/smaller than green etc)?
more and more these days doctors show me my blood gas results, in fact the nurses treat me like im staff (turning on/off oxygen, filling nebs, etc, nothing major, and obvs only my stuff while they watch!!!) that i wonder if some of them think i am a nurse or summit. now as i have good o2 sats, i sometimes get high o2 levels on a neb or if i dropped on the way there and they leave me on non-re-breathe for too long!Anyway, i wondered if that *causes* higher co2 levels, as i know that people with copd cant have too much oxygen as they'll retain too much - but not sure if its the same for asthma! or is co2 pretty seperate?
when they measure your o2 with a sats probe, i know there are plenty of things that lower the readings,do things also increase it? coz if not, surely they should record the highest number even if it wont remain on the higher number??
When they measure BP, when is it likely to be highest. First thing this morning my BP was really low. The nurse later said this could have been because i was lying down, but i thought BP was either stable whatever you were doing of dropped when you stood? i assume she is right - so how does it work?
i'm not concerned about any of these things but i really like to understand whats going on. I'm usually struggling to breathe enough to talk (and rarely can say more than a couple of words) so cant let my curiosity run wild and free while im there
Hope you are feeling better Soph and up on a more interesting ward!!
I think some surgical gloves have powder inside them to make them easier to put on. If you have ever tried to put some on it is very difficult especially if your hands are slightly clammy!!
Not sure about all the medical side/physics/chemistry of O2 and CO2 levels. I know my sats drop fairly early on when I struggle to get breaths in and out and need 100% to maintain above 96% and if they sometimes give me a neb wothout putting it through the O2 then my sats will drop. My biggest problem is my CO2 levels as I get more tight/restricted as I can't breath out enough for my lungs to blow off the CO2. Don't know if that helps but I guess during an attack your O2 levels and CO2 levels are all correlated in someway-I'm sure someone more medical minded can put it better than I have!!
O2 probes are not very reliable and just having cold fingers can change the reading and I think they use it as a rough guide along with other symptoms you are presenting with to get a bigger picture IYSWIM. I usually have my arterial blood gases done fairly early on to give a more accurate picture of what your O2 levels are doing. I'm sure there are things that make it go up or down but I think they watch it for a few mins and take an average reading. I think the readings can help to see if you can maintain your O2 levels off oxygen etc.
Not really sure about the BP query. I know low blood pressure is usually nothing to worry about especially if it was a one off. Ideally you should be sat up for BP so this could what the nurse meant.
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thought you guys probably know as much as most docs anyway!
pre-treating
