It’s the Intensive Care Unit. Things can happen fast and furiously. To a patient, it can be a blur.
Time… that is the critical key. Time can mean lost brain in a stroke. Time can mean lost heart muscle in a heart attack. Time can mean lost kidneys, liver, intestines, or brain in trauma. Time can mean unrecoverable respiratory distress. Time can mean life and, time can mean death.
Saving time means a flood of nurses, respiratory therapists and a doctor or two, flood your hospital room, doing 20 things simultaneously… monitors, assessments, medications, starting IVs, running oxygen, breathing treatments, running for supplies, documenting, and explaining what is going on to you and your family, as your room looks like a swarm of bees.
And in another perspective, my patient’s… Time can mean stress, fear, panic and trauma…
One night I helped admit a patient to the Intensive Care Unit who came in with a diagnosis of angioedema from an allergic reaction…
Angioedema means swelling of the airway, which if severe can be life threatening and possibly fatal due to swelling of the airway to the point of stopping someone from breathing. It can happen from allergic reactions to any type of allergen: food, medication or aerosols.
Angioedema can be extremely frightening to a person and to a friend or family person watching and wanting to help them. At first your throat feels a little lump. Then it feels a little hard to pull the air in. Suddenly you notice you are having to pay attention to your work of breathing. Every sensation seems exaggerated… the movement of the air into your throat, the rise of your shoulders and chest to help pull the air in. The sensation of trying to open your throat and chest more by moving forward. It is as if you are watching yourself try to breathe.
By the time you realize you are paying more attention to the sensation of breathing in your throat and not noticing anything around you… you are in trouble. You notice things like, you are sweating. You are so focused on what is going on inside your body, you don’t seem to be able to see anything around you.
You have minutes before your airway swells shut and no air gets in at all. After that, if there is no rescue treatment, you will pass out. From then, your body will still try to breathe, and when it realizes it can’t, it will stop. Within minutes, your heart will stop from lack of oxygen. By the time only 8 minutes has passed… your brain starts to shut down. Without resuscitation and opening of the airway, you will die. 8 minutes between reacting to something you turned out to be allergic to… maybe you didn’t even know you were allergic to it … and death.
If you were able to call 911 emergency… and if they were able to get to you in time… the mere presence of what seems like a swarm of bees around you doesn’t calm you. It just takes you out of your inner focus and inserts the chaos of the energy around you. One of two things can happen now… the chaos can be overwhelming and you shut it out or pass out. Or, you feel a sense of safety and security with the rescue efforts and start to relax.
People run around you in a blur. They ask questions. They give instructions. They explain what is going on and what they will be doing to make you feel better. You have hands starting an IV line on each arm. Hands putting on oxygen. Hands taking off your clothes and putting on the heart monitor pads. Hands putting on blood pressure cuff and a pulse ox to measure your blood pressure and oxygen level. Hands everywhere!
Treatment for angioedema requires injectable steroid medication to aggressively decrease inflammation and swelling of the airway. Steroid doses can be high enough to quickly reduce swelling, but side effects can include agitation, insomnia and restlessness or hallucinations. Anti-inflammatories such as anti-histamines can reduce or reverse the causative allergic response. Intravenous fluids will help flush the allergic mediators and reduce swelling. Anti-anxiety medications can reduce anxiety related to fear and the trauma and help relax the physical and emotional work of breathing while all the other medications are working.
To be honest, you probably only really listened and absorbed less than 10 percent of it. You feel like a zombie. And everyone is walking too fast, talking too fast, and it is all a swirl as you nod you head, try to focus on them and answer their questions.
If treatment is successful, it needs to be fast… within an hour, to save the time of further consequences.
Even as treatment is successful… you are still recovering. An impression has been imprinted on you… your brain, your body, your mind and your memory.
Recovery can mean the residual of trauma. Patients have told me stories of waking up in a start, with breathing problems, in the middle of the night, in panic, even though they didn’t go to sleep that way. With further discussion, you find out, the sudden distress occurred at the same time of night that your initial breathing distress occurred. You are beginning to forget… but your body and mind are still hanging on in fear that it will happen again… and your mind and body wakes you up fast and fretful.
Patient’s say they can’t sleep in their bed if when they lay down, it reminds them of being in the ambulance. They sleep at the foot of the bed. They sleep on the couch, in a chair, in a hammock. They have trouble sitting on the same spot on the couch where they were when the ambulance came. Even a short try, will invoke anxiety and an asthma attack – on the sole instigation of their memory.
Some patients report that aromas are now too strong… perfumes, aromatherapy, candles, cleaning solutions… all things they used in the past and liked… now make them feel like they are choking. Emotions are powerful triggers. Anger, yelling combines the force of action on the throat with increased anxiety… and the throat starts to choke. And that sensation triggers fear and anxiety of a repeat performance of their emergency.
Someone innocently plugs in an aromatherapy diffuser in your office… it smells pretty… then is suddenly over powering… and you feel it tickle the back of your throat… and it all comes rushing back…
How long does it take to recover? Everyone’s experience is different. Body memories are real. They are powerful. And they can be debilitating. And they deserve to have someone understand how frightening it was to go through it. And more importantly, what is left to remember and deal with every day.
Call me today and let’s tell your story.
Helping You Find The Answers
[Original Post 05/13/2015]