No SOB, no complaints, but wheezing?

[croaker260]

Croaker, no intent to challenge your observation, I think I see what your trying to say, but many brittle severe asthmatics have a "silent chest" so would you call that asymtomatic too ?

No intent to pull rank but other than working in the back of a rig have you dealt with a lot of long term care hospitalized COPD patients, your theory is a bit of a stretch although not incorrect as they all do differ, especially those on supplemental O2.

The very broad term used in EMS that of "wheeze" is very often a "catch all" in fact inspiratory vs expiratory was never questioned in this nor any more PMHX nor meds.

I can tell you with all sincerity that I have been informed by many Paramedics and RNs upon taking report of a wheeze, but one cough or one deep tracheal suction and suddenly the wheeze is gone, as I said prior all that wheezes is not asthma, i was intending to introduce cardiac asthma as a possible diff dx .. but when patient was texting while driving, well I suddenly lost interest.

Cardiac asthma is a medical symptom, of wheezing due to congestive heart failure.

I think you misunderstood my post entirely. Utterly. Completely. Totally.

My comment was on the OP's use of the term "asymptomatic" , where i believe "symptomatic at their baseline" a better descriptor of some of our patients (not necessarily the OP's scenario, but pertinent tot he overall discussion).

In fact I was saying...if you re-read my post...that the patient was not "asymptomatic".

Since your comment that I was saying this patient was asymptomatic is based on a false assumption, I will leave your other comments regarding a silent chest, not to mention the physiology of end expiatory wheezes alone.

What I posted was a comment on somatics, the perception of patient severity, some basic philosophy of medicine, and most of all a basic understanding that people live with chronic disease process that are indeed symptomatic and impact their daily lives, and their daily lives had adapted to that reality...

I was also saying that it is perfectly appropriate to help a patient (after thourough subjective and objective assessment) continue to control their own disease process through continuing their own regimen of broncheo-dilators on their own schedule while they are in your care, even if they dont quiet meet the criteria of urgent/emergent/in distress.

I will give you points for the cardiac asthma train of thought. It is a reasonable differential Dx, but still not mutually exclusive of my comments either. This is where the subjective (including a thorough history) and objective assessment helps you determine the best course of action. After all, 70% of your working field Dx is gleaned from talking to (and listening to) the patient.

And, for what its worth...I have a fair amount of experience with patients over extended periods of time including loooong CCT transfers (fixed wing and ground) , as well as in hospital experience as well. I am well aware of the physiology of "cardiac asthma" as well as non-cardiogenic pulmonary edema in all of its various flavors, not to mention various breeds of pneumonia (fungal, aspiration, community acquired, institutionally acquired, VAP, viral, and my personal favorite to read about...parasitic) . That said, like everyone on here, I can always learn more.

To end my rant on a positive note:

Off the top of my head the longest respiratory patient I have had to deal with was 14 hours on fixed wing between Seattle and Joplin MO. Clinically a very interesting flight, but not as interesting as the bovine-hormone saturated exotic dancers I saw afterward...but that is another story.

namaste'

After careful review, and seeing that my original post was quite brief, I apologize if I came across harsh.

Sometimes the thoughts we are trying to convey come across our brain but seldom make it past the keyboard.

Edited August 1, 2011 by croaker260

[tniuqs]

After careful review, and seeing that my original post was quite brief, I apologize if I came across harsh.

Sometimes the thoughts we are trying to convey come across our brain but seldom make it past the keyboard.

No worries I am happy you added the "edit" as my head was going to implode or explode not really sure which and croaker the in comments highlighted, welcome to the club will you support me in my bid for president ?

Now these interesting bovine-hormone saturated exotic dancers I saw afterward...but that is another story ..... please feel free to share your insights PLEASE and Bless You.

[BushyFromOz]

No cookbooker here mate, do you need respiratory distress with a history of asthma to treat a wheeze (I think your just being a pussy) LOL.

With your post your suggesting MDI with spacer is less aggressive than SVN ... hmm careful there don't make me pull out my studies !

pretty poor choice of words eh!

My forum-fu is weak today

[croaker260]

No worries I am happy you added the "edit" as my head was going to implode or explode not really sure which and croaker the in comments highlighted, welcome to the club will you support me in my bid for president ?

Now these interesting bovine-hormone saturated exotic dancers I saw afterward...but that is another story ..... please feel free to share your insights PLEASE and Bless You.

The short version of a long and tedious comedy of errors story...After said 14 hour flight (should have been about 7) which ended up at midnight in the destination city. This was after an allegedly simple respiratory patient not tolerating altitude very well. Additionally, our "destination"..allegedly rehab hospital was in actuality a hole in the wall roach infested nursing home.

So , after fighting with the doc and getting the patient actually admitted to a hospital.......the only place to eat was a restaurant right next to the strip club...apparently the only two places open after midnight that we could find. And the dancers got off duty right as we arrived. They flocked (waddled) to the same eating establishment that me and my partner were visiting.

Well.... exhaustion does funny things to the brain, and I already have some difficulty keeping my mouth shut... so after some poorly thought out comments ...its always funny to see two full grown men in flight suits getting yelled at by a glittered covered stripper who outweighs them. This is in between getting hit on by the waiter (who was wearing makeup).

On a good note, the food was decent. And we didnt end up in jail.

Edited August 1, 2011 by croaker260

[Katiebug]

Where the hell were you?

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[croaker260]

Where the hell were you?

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Joplin MO

[hatelilpeepees]

He has asthma and just got the crap scared out of him. I would ask him if he felt like he needed a breathing treatment, since he knows his "asthma". If he said yes, I would let him use his inhaler or give him one treatment on the way. Its no different than asking someone who is always on oxygen if they feel like you need to bump them up another liter. If he had no history, I probably would not, but would report my findings to the ER staff so they could do a CXR and see whats going on.

[DwayneEMTP]

....hmm careful there don't make me pull out my studies!....

Thank God you said studies...just saying. Sometimes the forums seem to dictate a different kind of exposure...(Yeah, pun intended)

Dwayne

[BushyFromOz]

Whats the go woth this "breathing treatment" crap?

"on my last shift at work, i perfomred an angina treatment, a broken leg treatmnet and a low blood pressure treatment"

It just sounds retarded.

[croaker260]

Whats the go woth this "breathing treatment" crap?

"on my last shift at work, i perfomred an angina treatment, a broken leg treatmnet and a low blood pressure treatment"

It just sounds retarded.

"Breathing Treatment" is just common vernacular over here, because its understood by the lay public easier than "nebulizer" or more specific terms. How it became a standard part of the EMS lexicon is rather inane, but it has none the less.