Tuesday, May 30, 2006

Frequent Flyer

Last time I was in the ER with one of my kids I told them I wanted frequent flyer miles. They laughed. They thought I was kidding.

5 times in the last 10 months I've spent my evening in the local ER. Most were good experiences, as such things go. I won't be upset if I don't get to visit them again any time soon, though.

One recent visit resulted from an unexpected reaction to SOMETHING UNKNOWN by my middle son. He'd had a cold, but seemed to be recovering. He had a coughing spell and suddenly was just not moving air well at all. He was moving just enough air to wheeze and to manage about a 400 on my peak flow meter. Not too good for an athletic, non-smoking, 6'tall, 20-something male. More typical for him is the normal range of 650+. Yes, he's played with peak flow meters before, so he knows.

Since he'd just returned from dinner at a local restaurant, I asked about any new or unusual foods - just chicken and rice, not likely culprits. I seriously considered using my epi-pen and calling 911, but he threatened violence if I tried. I wasn't sure he was kidding, so I talked him into taking 50mg of liquid benadryl and off to the ER we went.

Sudden onset respiratory distress gets you triaged pronto and even a "breathing treatment", but not much more. The triage nurse and the RT were happy with an Oxygen saturation of 95% post treatment, even though it had been 98% pre-treatment. "See, he's not wheezing any more," they both said.

"You have to move air to wheeze," I pointed out - to no avail, so off to the waiting room we went.

A very long half hour later we were escorted to a room. My son introduced his nurse as "one of the good ones." The (new) respiratory therapist was appropriately concerned by the decline in O2 saturation, the respiratory rate of 30, and the lack of response to the initial treatment. After a brief consultation with the ER doc, he returned with a different type of nebulizer and spent 20 minutes explaining why the first treatment hadn't worked and how my son could alter his breathing to make this one more effective. One more treatment and we were ready to leave, prescriptions in hand.

One of the RT's I work with in the NICU at a different hospital explained that not many hospitals in our area use the breath-triggered nebulizer that was so effective for my son. They're more expensive. I don't know how much more expensive, but I'm fairly certain that without that nebulizer, the next step would have been IV steriods and possibly an admission. That makes me think having them around as a back-up would make for possible significant cost savings.