A&E question?

I'm sorry to make another thread.

I'm ok at the moment.

there's been a few times over the last few days where I've thought I was gonna need A&E but have been like ""I have no wheeze, although I'm nearly coughing a lung up and my chest is that tight that it hurts, I feel like I'm breathing through a straw and I'm not getting enough air in, apart from the coughing, there's no proof really, there's no point""

I'm already on pred (40mg) and out of hours doctor refuses to see me if I'm on steroids as ""there's nothing they can do"", they always advise A&E.

its better to go to A&E to be on the safe side isn't it? even with asthma which isn't exactly textbook case and probably doesn't seem like there's much wrong to anyone outside?

sorry.

16 Replies

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  • as annoying as it is, yeah if in doubt you should get to A&E, sorry!

    if it helps your treatment then i'd carry a bit of paper that says your asthma is not typical

    if it helps motivate you to go then just think- if things went really wrong - where would you rather be, A&E of home? no matter how useless doctors can be, and how poor their understanding sometimes is, they are the best group of people to have around if you stop breathing!!!

  • I'm sorry to make another thread.

    No need to be sorry. Different questions deserve different threads.

    its better to go to A&E to be on the safe side isn't it? even with asthma which isn't exactly textbook case and probably doesn't seem like there's much wrong to anyone outside?

    As a general rule, I think so. Even if they do nothing except watch you sit in the waiting room with a good book, you'll be close to help if things become really bad. Most very unpleasant asthma attacks just stay at scary and unpleasant, but just in case this is the one that doesn't it's good to be close to help.

    I may just have been lucky, but I found that the three times that I went to urgent care last December they dealt with me well. I also don't look like much is wrong on the outside: I don't panic; my breathing is usually steady and calm because I've worked to keep it that way; I usually don't wheeze in ways that are easy to hear; and even though my nose is flaring and I'm using accessory muscles to help me breathe,most people can't see it because (a) flaring on an adult nose is hard to see (b) doctors typically looked at the neck and not the muscles I actually used which were down below (abs, lower back, chest cage) and covered with bulky winter clothes.

    Since they couldn't see what is going on easily, I did two things to help things along. First, I describe to them the symptoms they can't see without getting upset about them saying some version of ""but you seem ok"". So for example the first two visits I told them: ""I know my oxygenation is good, but I'm really working hard to breath, much harder than I should"". Since my heart rate was also mildly up (120) it wasn't too hard for them to believe me.

    Second, after the first visit, I brought along documentation of my asthma: a letter summarizing my case history and spirometry results that show I have asthma even if I don't wheeze. No one's ever asked to see the spirometry, but I think the fact that I come armed with a doctor's assessment and not just my own ideas about my health makes them take me more seriously. Never hurts to have backup.

    If going to A&E just to be on the safe-side happens frequently and begins to get annoying, then it's probably time to have a chat with your GP about what they think you should do. When does your GP think you should wait until morning for an emergency appointment or phone consult? When does your GP think you should go to A&E?

    There is no one answer anyone here could give you. The answer can differ a lot depending on (a) how much risk you are for a life threatening flare (b) how good you are at telling when something could be life threatening *long* before it actually is - waiting until you flat out stop breathing isn't going to give the guys in green a lot of time to help you (c) how comfortable both you and your GP are with you managing lesser attacks at home.

  • I haven't been in A&E in about 16 months with my asthma, although I probably should have been a lot more. my gp doesn't really have anything to do with my asthma, she's great for everything else apart from my asthma - ""no wheeze, not asthma"", despite not being a wheezer, I'm diagnosed (through lung function tests and other things) as severely asthmatic, luckily I'm well controlled most of the time. when things get wobbly, I can go (and often do) have severe attacks come on out of nowhere with NO warning signs, I manage to put them round with a stupid amount of salbutamol at home. I usually stick with my cons.

    he's said if I can't breathe through coughing, chest tightness or talk through shortness of breath, or if my PF has dropped below 240 to ring an ambulance (blah, they scare me, heh), if I start struggling for more than a couple of nights, IE, waking up coughing, shortness of breath, tightness and again, a drop in my peak flow which doesn't improve, to double my inhalers, the same goes for during the day, if I'm struggling to cope with ""every day life"" to double my inhalers, if they don't help any after a couple of days, to see my gp to get oral steroids which is a task in itself.

    I've managed to lose my peak flow monitor while I've been rearranging my bedroom, so at the moment, I'm going how I feel my peak flow was 280 yesterday when I was at the doctors, I feel pretty crappy today so I wouldn't be surprised if its dropped even further, not coughing too much at the moment, but my chest and back are really tight and it doesn't seem to be letting up any time soon with my inhalers and occasionally, it feels as if the air gets stuck in my lungs, it lasts a couple of minutes but I seem to have to put a lot of effort into breathing until its eased off. debating ringing NHS direct to see what they suggest. heh.

    I've had attacks where I've been fine, then blueish 5-10 minutes later (mums words, not my own), usually resulting in rapid response and the ambulance at my house, often getting told there's no wheeze I'm not asthmatic, despite coughing my sats down to high 70s-low 80s, when I'm not coughing, they usually sit around 92-95%.

  • Sounds like a conversation with your cons about when to go to A&E/ring for ambulance is in order - your description of your action plan sounds very detailed for handling yellow-zone issues but doesn't say much about when to stop trying the sabutamol and get extra help.

    There is a limit to what sabutamol can do in a very severe attack and you may need other sorts of help. Unless you and your cons are in agreement that a stupid amount is the way to go, doing that sounds rather dangerous. This is especially so, if you are the sort where others notice you are turning blue before you do. I'd worry that you when you feel poorly, you don't always see how poorly.

    Perhaps you could also ask for some sort of letter from the cons describing you as a non-wheezer that you can give to ambulance personnel? If an incident like the one where your mum saw you turning blue ever happens again, that's not going to be when you want to give a paramedic a long winded description of your personal history or a lesson in the many varieties of asthma.

  • I've got a cons appointment in 11 days. I'll ask about ambulance & a thing for being confirmed a non-wheezer.

    its kind of weird, when I feel rubbish, I'm not normally too bad, when I don't normally feel too bad, I'm normally in a bad position. I always assume that I'm ok, when I'm A&E, I usually get nebbed with salbutamol and atrovent, pred/IV steroids then a couple more nebs and usually moved onto medical assessment for observation, if I'm kept in, usually a couple of more nebs overnight and discharged the next day with steroids & antibiotics most of the time.

    when I first went blue from an attack, it was my first ever hospital admission, it'd come on over 5 minutes, was fine and talking one minute, the next I was coughing and couldn't catch my breath at all between coughing fits, mum had rang ambulance and the woman on the end of the line was concerned apparently. I had a massive panic attack over the top of it keeping my oxygen levels up to 100%, once the paramedics managed to calm me down, my sats dropped to 91% and put me on nebs and said it wasn't even asthma because my cough was dry and my chest was clear?! turned out in A&E I had a severe chest infection and my temperature was really high (hit almost 43 at one point). I've started noticing when I'm going odd coloured, my lips usually go blueish purpleish and my nail beds go dark purple now, hands also go really pale, if I pick up on it, I usually drag myself to A&E then.

  • A and E are often no help I ring my out of hrs gp and he sends me to MAU to get assessed maybe ask yours if he can send u there rather then A and E xc

  • out of hours are no good with me :P they decide that I'm on steroids, there's nothing they can do and say they can't do anything, if I'm not on steroids, they usually give me antibiotics to be on the safe side.

    at this rate I'm gonna be surprised if I'm out of hospital before the end of the night, the top of my back is becoming increasingly tight and painful and its not letting off.

  • A&E for me according to NHS direct. >.<

  • Good luck xxx

  • As I was reading through I was thinking that OOH are not going to be any use as they always say ""if you're on steroids already then we can't help, go to A&E"" and NHS direct will just say ""go to A&E"" as they do if you tell them of any breathing difficulty. I've never found either service to be useful.

    Hope you get some good treatment at A&E and are well enough to go back home soon. xx

  • Hate the dilemma of ""too ill for OOH, too well for A&E"" vaguely in that spot atm, lungs just about holding their own atm but suspect ill be visiting A&E soon :-( so frustrating - i was due to have my last day of steroids tommorrow - i could cry! Got my bag packed just in case - gonna try and get some shut eye. GRRRR! so cross! hope A&E are good to you and that you are well enough for home soon! x

  • Me too waiting for a blunce. Arrggh managed a whole 18 days out of hosp...stupid lungs

    good luck to all

    rose xx

  • looks like we're all going in today! sigh! its a lot less exciting at night - i like the sirens they're entertaining! also makes it much harder to work out when they've arrived! sure mine'll be here in a min though - although they have a stupid rule about not having lots of ambulances at the uni and on a friday i have to compete with alcohol poisioning! sigh! hope you dont stay in too long (because you get better really fast) :-)

  • I want to steal the consultant, I've found someone who's not on the one of ""no wheeze, no asthma"" :D he was lovely, stayed with me for 2 hours after he was due to finish, got me stable and came and said he was handing me over to one of his other people.

    I hate nebs, 5 of them over a 2/3 hour period and I was shaking enough to make the trolley shake, THEN had to sit around for ages for my heart rate to come below 80. *grumbles*.

    I'm a happy teddy, breathing is slightly easier and I have a course of antibiotics which know work. if I have another coughing fit which I can't physically take my inhalers for, there's no ifs or buts, I need to ring for an ambulance apparently.

    my chest x-ray says I have double, but fairly mild looking pneumonia. >.<

  • I want that cons too, will you share him? I'm glad you got looked after well and I hope you're feeling better soon now you've got antibs.

    Soph and Rose- hope you're both feeling better soon too.

  • haha, there definitely needs to be more people like him, the best experience I've ever had with anyone, including when I first started seeing my cons.

    I don't know if my chest has admitted defeat and has decided to start shifting mucusy stuff from my lungs on its own, or if its to do with the antibiotics I'm on - I definitely seem to be more productive since I took my clarithromycin last night, I've woke up and coughing stuff a lot more with what feels like a lot less effort.

    here's to hoping I'll be back to myself soon enough.

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