What do emergency services actually do?

[Richmond162]

Hi since being diagnosed with PMR and GCA and at mo on 40mg steroids till end of month and then reducing. I understand about protecting sight, which is so frightenening. But I would like to know is if one has symptoms painful headaches etc associated with this and an emergency call is made, what do the emergency services actually do for the person please? Do they just pump extra steroids in? If so, would it be worth carrying extra steroids just in case something drastic goes wrong? Thanks.

[DorsetLady PMRGCAuk volunteer]

They don’t ‘just’ pump in extra steroids, they do tests to confirm it is GCA or a flare thereof….headaches can be caused by all sorts of illnesses not just GCA.

…and tempting as it might be, self dosing with high amounts of steroids is not a good idea. They are very powerful drugs, please leave that decision to the medics.

[Richmond162 in reply to DorsetLady]

Thank you for explanation. A friend was curious as to what they would actually do in an emergency and I really did not know the answer!

[Ronzy in reply to Richmond162]

Well I thought that a good idea at the time .Last time I had pmr.the doctor who diagnosed me was fantastic put me on about 40 to start with,dolled out pred like sweats ,eveytime I saw him he would say ,o you must never be without these Bless him .😢then not too long down the line he retired 😫 .

Consequently I had quite a stock of pred.

Soo when I felt almost sure I had contacted GCA I immediately took lots of steroids

To kill it Butttt then going to the doctor,simtoms gone saying no not GCA ,no symptoms 😱🤷🏽‍♂️ Soo be warned,get yourself to a&e ,let them note your symptoms 😤

All the very best Ronzy 🍀🍀

[PMRpro Ambassador]

What the emergency services do depends on the reason you called them.

In the Yorkshire Ambo Service they are trained to recognise potential signs of GCA - but if you were having visual symptoms, especially amaurosis fugax (transient loss of vision) or blurred vision or severe headache they would almost certainly take you to hospital for a differential examination because that is also typical of stroke - the ambo crew can only treat what they see and keep you going until you are in A&E/ED where they have equipment and doctors. They are unlikely to give you large doses of steroids in that situation but they would take you to hospital for clarification. After all, severe headache or visual problems that could be a stroke makes it very inadvisable to drive yourself.

If you were having signs of an adrenal crisis at lower oral pred doses, and they thought it appropriate, they would administer i.v. or i.m. hydrocortisone and almost certainly i.v. fluids before transfer to hospital for clarification.

[Richmond162 in reply to PMRpro]

Thank you so much for explanation. A friend asked what the procedure would be in an emergency and I did not know the answer. Thank goodness for this forum and the experts like yourselves.

[PMRpro Ambassador in reply to Richmond162]

Only really know because one daughter was a paramedic and now is front-line A&E as an advanced care practitioner (qualified to do everything junior doctors do). And I did specify YAS - since they teach their paramedics and even relatively small hospitals have a GCA protocol, and send patients to the Big Hospital if necessary.

[123-go]

Any new headache with PMR/GCA should be reported immediately. If accompanied by blurred or double vision this should be treated as a medical emergency and calls for a prompt visit to A and E or 111 call.

[2013mayo]

Hi, Well it happened to me over a weekend, I phoned the out of hours doctors, he told me to go straight to A/E, I hasten to add they were useless, after the receptionist tried to contact the eye hosp it took an hour for them to answer, they said a duty doc at A/E would see me, would have to wait another 1-2 hours, it was decided I’d see a on call doc based just outside A/E. The on call doc phoned emergency rheumatologist who then told her I should up my pred (phew).

So yes If emergency if it’s over the weekend they just increase your pred.

[Nextoneplease in reply to 2013mayo]

Hi mayo 😊

Honestly I think that service was, shall we say, less than ideal, depending of course on your symptoms.

I had to go to A&E late on a Friday on my GP’s recommendation, before I was diagnosed with GCA, and they did basic sight tests, blood tests and general physical and neurological examinations. They didn’t at that point think it was GCA but they did refer me urgently to a rheumatologist who said it was….

Had I had more evident GCA symptoms they might have increased my steroids there and then. If necessary, they do admit people and sometimes give IV medication. I’d say never leave it to chance, A&E will decide what to do based on your individual condition.

By the way, on that occasion I didn’t call an ambulance, I got a taxi there (rightly or wrongly).

All the best xx

[Richmond162 in reply to 2013mayo]

thank you so much. Glad to hear you are ok after a frightenening experience.

[Sharitone]

It's relatively easy to wait for an ambulance, but if your GP tells you to go to A&E, and it is a long drive, then it's still tempting to take at least some more pred as a precaution. I don't know whether that is ok, and maybe some kind person will tell us. When I developed GCA, I was on 14mg; the GP told me to go to A&E and take an extra 1mg!🤣 (But he's very sweet!)

[PMRpro Ambassador in reply to Sharitone]

Well he was right enough about A&E although I hope he provided a letter for you!!! Not sure what he thought 1mg would do!!! At one time many rheumies insisted their GCA patients keep a back-up stock of a high dose which they should take if they had any visual symptoms before heading for the hospital, not wasting any time about it.

[Sharitone in reply to PMRpro]

Thank you, kind person. I've always thought I would probably take an interim 20mg.No, no letter!

[PMRpro Ambassador in reply to Sharitone]

My optician in Scotland used to see anyone with vision problems ahead of anyone else - I had to wait ages one day. He did all the tests (because he had better equipment than the hospital!), wrote a letter and sent them off in a taxi if they didn't have anyone to drive them and phoned ahead to be sure the right person saw them on arrival. I don;t expect the GP to be up to that - but they can write a letter!

[Ronzy in reply to Sharitone]

Mm sweet and useless 😤 sorry getting to me a little 😢. Am going into battle tomorrow with my sweet and useless doctor 🤷🏽‍♂️😵‍💫.not sweet if someone looses eye site ,when it’s gone it’s gone 😱