Running on Empty

   Attack One responds at 4 a.m. for a woman with difficulty breathing. They find a 52-year-old lady in moderate respiratory distress, alone in the kitchen of her apartment. She reports the shortness of breath came on during the warm evening hours, and she found no relief using her nebulizer treatment over the last hour. She denies chest pain, fever, productive cough, nausea or swelling in her extremities. She has a history of "heart and lung problems" but can't provide much more detail about either. She is too short of breath for lengthy conversation about her medical problems.

   The patient has a tight chest and a lot of wheezing on initial evaluation. The crew asks her if she'd be willing to repeat a nebulizer treatment in an attempt to relieve her wheezing, even though she reports having one about an hour ago. She agrees, and they fill the nebulizer cup with albuterol and ipratropium and turn on the oxygen to power the system. As they complete her assessment, she reports feeling better and can reply to some medical questions.

   The crew asks about her specific heart and lung problems, and she says she had lung cancer and an irregular heartbeat, as well as COPD and asthma. She knows she was under treatment for diabetes also. She says she doesn't have a list of her medicines and doesn't know what her allergies are. "Where are your medicines?" a crew member asks, wanting to collect them to take with her to the hospital.

   "There are some in the kitchen, some in the bathroom and some in my sitting area where my machine is," she replies, referring to her nebulizer.

   The EMT sets out to collect them and place them in a bag. As he finds them, he reports them to the paramedic to compile a list on the run report. There are bottles everywhere, with various pharmacy names and physicians who had prescribed them. The paramedic finds a number of medicines close to the nebulizer and adds them to the bag. As she collects these medicine bottles, she notes the inhalers are old and, shaking them, finds them empty.

   "Where are your new inhalers?" she asks the patient. "And where is the medicine you add to your nebulizer to help you breathe?" The paramedic had only found small nebulizer containers of saline, and no small containers of albulterol or similar medications.

   The patient replies: "Those are all my breathing medicines. I just don't understand why they don't work!"

   The patient is in the kitchen completing her nebulizer treatment, and the paramedic with her contemplates that second sentence.

   "Ma'am," that medic asks, "can we ask you to walk out to the sitting area with us to show us your medicines? We don't want to miss anything. We will carry the nebulizer out there so you can continue your treatment."

   The patient walks out and sits down. She looks at each of the inhalers and confirms those are her breathing medicines, which she uses two or three times a day by spraying them in her mouth the way her doctor showed her to. The normal saline packet, she says, is the medicine she uses three or four times a day in her nebulizer.

   The paramedics look at each other in simultaneous recognition. The female medic speaks first: "Ma'am, we are going to take you to the hospital so the staff there can treat you. We'll ask them to help you understand your medicines and how to use them better. Right now all the inhalers you're using are empty, and your nebulizer doesn't have the active medicine in it. That's why they aren't helping."

   The patient still doesn't seem to understand, and the paramedic tries a couple more times, using different terms, to explain the problem. Still not getting through, she decides they'll take in all the medicines they found in the house, as well as the nebulizer, and ask hospital staff to explain the use of all the medicines once the patient is feeling completely better.