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RE: A&E Response to critical attack


The other week I had an awful attack, which admittedly I didn't help by have 1/2 hourly nebs for 12 hours at home until i gave in and got my mum to drive me in (I know its awful but am embarassed to go in an ambulance).

Anyway when I got to A&E, i was seen within 5mins and put in majors. I was given two b2b nebs of atrovent and sabutamol while a doctor tried to get a needle in....it took 6 tries and at least 20mins. I know they were saying I was shutting down but those 20mins were agony and I was wondering if it is normal to take so long...after two doses of hydrocortisone the doc was stil indecisive and called paeds who moved me immediately to Resus and started aminophyline within 10mins.

I'm now in adult medicine and am very scared at how slow A&E took to treat to me and get a cannula in....the doctor was very hesitant to put any mag sulph/aminophyline and without paeds I'm scared i could have ended up in ICU.

I'm sorry about this little rant!!!

May xxx

1 Reply

Hi May,

I'm so sorry you've had such an awful and frightening experience. I've had similar ones so I do know a little of what you are going through.

As far as getting the needle in is concerned - it's difficult to say really. Sometimes on me they will get one in first time, other times it will take several tries, and occasionally they won't manage it and I'll have to have a big central line in my neck. It depends on several things really - how good your veins are to begin with, how many times you've been cannulated/had blood taken recently, how sick you are (they are right to say that the veins can begin to shut down if you are quite poorly) and how experienced the doctor is (and there are some very new doctors around at this time of year). Have you been cannulated often before, and is it usually difficult? You may well find that it was a complete one-off and that if you need a cannula again it will be very straight forward next time. If it is not, I know it is scary, but try not to panic about it too much (easier said than done I know) - there are always other strategies they can use, such as putting in a big central line (the big veins are easier to get into and don't shut down as much when you're ill) or even getting one of the anaesthetics or ICU docs down to cannulate you - they are real experts and can usually get a cannula into pretty much everyone.

I know it's a horrible experience to be waiting for so long to get the drugs you know you need, and it is really panic-inducing, and I know that things like cannulas and bloods always seem to hurt much more when you are in that sort of state, so I do sympathise.

In terms of the delay getting the IV mag and amino started - non-Paeds doctors can unfortunately often be quite nervous of treating young patients, even in A&E, and they do often like to get a Paeds opinion first. I know the delay doesn't help things and probably makes you even more anxious. Do you have a letter from your consultant detailing your past history and protocol for management of acute attacks? I find that having a letter to wave under doctors' noses, especially one with the all important consultant signature, will usually make even the most reluctant doctor start IV amino fairly quickly. It also helps that my husband and family are thoroughly drilled to say 'she needs IV amino' and keep saying it till I get it! My hubby Alex is not naturally a pushy person at all, but he has learnt to be quite bolshy in that situation if it is required.

As for the 1/2 hourly nebs for 12 hours, and getting your mum to drive you in... well, I won't say anything, because I'm sure you know and you're scared enough already. Also if I did say anything about it, it would have to be a case of 'do as I say, not as I do' - we've all pushed our luck on occasion and regretted it afterwards, I think it is a normal part of finding out what your limits are. I agree with the ambulance thing - I hate them too, it's embarrassing when all the neighbours are peering out the windows at you, they're claustrophobic and they make me feel travel sick! My husband now refuses to drive me in, though, as he's seen me go off suddenly one too many times, so I guess I am stuck with the ambulances! I can see his point, because if I were in the car with him driving and I became more unwell there wouldn't be a whole lot he could do about it.

Hopefully as time goes on and you have time to process things you will be a little less frightened by this whole experience. It often helps to talk about it - whether that's to us, your family, your GP or some of the doctors involved in your care at the hospital. Having a bad asthma attack, as I'm sure you know only too well, is always a horrible and scary experience, but by having a few things in place you can reduce the risk of things getting worse and have the reassurance that things will happen the way they should, which does make the whole thing less scary.

Hope this helps. I think you are doing really well - I don't mean to sound patronising, but I am sure that if I were having severe attacks when I was your age I would not have coped nearly as well. Thankfully my asthma was only moderately bad in those days, but I still did not cope too well!

Do PM me if you want to talk it through more, or anything else

Em H


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