"67 year old female, Asthma attack"
I like asthma attacks. It is one of the few jobs where our actions can cure someone in front of our eyes. I've been to people who are a few minutes away from death and after a few drugs, a hope and a prayer, they are sat up talking to you. Most of the jobs we do we never see the results, or hear the outcome, and that can be really frustrating, so it is refreshing to see the fruits of our labour.
We got the job in the middle of the night and after a short run we arrived on scene at the same time as the FRU. We piled into the tiny lift and went to the 8th floor. As we entered the flat I could hear the wheeze! Never a good sign! Our patient was sitting on the edge of the bed really struggling for breath so we gave her a nebuliser straight away. She was a lovely lady, apologising for wasting our times in between gasped breaths! It always amazes me how the elderly feel they don't deserve an ambulance when they are in fact the most deserving. The nebuliser worked well and she was soon talking in full sentences. Job well done! We gave her a full MOT and suggested a trip to hospital would be wise but she refused. Our concern was that her symptoms would return and she'd need to call us back:
"Did you use your inhaler when this all started?"
"I tried but it didn't work. It's new but doesn't give any spray"
She had one of the new types of pump, no canister to squeeze down in the traditional way, just a mouthpiece to breathe through. When you inhale it delivers the required dose of spray. Simple! I asked to have a look at it. She opened her drawer and passed me the brand new looking inhaler. I opened it up to see if the canister was full. It was. I manually squeezed it to see if it was working. It was.
"You do know that there is nothing to squeeze now don' t you?!"
"Yes, I read the instructions and did what it said"
"Can you show me what you were trying, we'll see if we can get it working"
"OK, i'll give it a go"
She put the inhaler in her mouth and took a deep breath in. Nothing!
"See!"
"You're holding it upside down, try it the other way up"
"AM I!!"
"Yes" I said, while chuckling away!
She turned it around, exhaled slightly and took a deep breathe in. The all telling sound of the spray was audible to all. Her face lit up with excitement!
"Well I never! You mean it wasn't working because I was holding it upside down? I'm so sorry for wasting your time. That's how I have always held it. The other style works that way."
I assured her that it wasn't a waste of our time and it was an absolute pleasure to help. It is worrying though, how ill someone can get from not knowing how to use their medication. The doctor or pharmacist should really ensure it is being used properly. I see similar cases far too often when patients who speak little english simply don't take their medication because they don't understand when they are supposed to. Luckily today, we were there in a timely fashion and were able to solve the mystery of the upside down inhaler!