Monday 16 July 2012

A Quick Fix

"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!


"You're holding it upside down, try it the other way up"

"AM I!!"

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!


  1. Rather glad I read this as I have an old style inhaler. Will remember it one day when I get the new one!

  2. When my friend got one of the new style inhalers a while ago it really threw her. She needed to use it right away (thanks to her surgery's crazy rules about when you can and can not ring to order a prescription) but it took a lot of messing about to work it out, fortunately for her she wasn't so desperate for it that she still had the rational capacity to work it out, but if you're panicking and struggling for breath it isn't always going to be the case.

    You would think that someone would have the sense to ask the patient if they've ever used the new style inhaler before sending them on their merry way and leaving you to pick up the pieces?!


  3. bit like having a pt told to take their GTN when they feel funny instead of only when have chest pain!!!

    1. YES! Then they take it when they feel dizzy! Doh!

  4. Great blog...I was actually changed onto the new-style during my asthma review and thus explained how I'd use it! Can see that it'd be confusing if not!

  5. Another series of great blogs. Truly inspiring and educational reading. I thoroughly enjoyed them again.

    Keep the blogging up and keep the great work up too.

  6. I had one of these auto haler things years ago - and it nearly killed me. It worked fine right up till the night I had a bad attack and it jammed. As my partner could drive and it would have made little time difference he took me to hospital himself - when I arrived the staff were amazed I was concious as my peak flow was not touching the scale.

    Give me the ones you push the canister anyday - less to go wrong at the wrong moment.

  7. It's amazing how many people can't take an inhaler properly! I've been on respiratory wards and witnessed all sorts of daft techniques - coming from both patients and nurses just plain telling people the wrong thing! The best though was a little old lady who was an insulin dependent diabetic too - she was spraying her inhaler at her stomach in the same way she would do her insulin!


  8. Mammywoo-

    You're a Goodun!X

  9. Mammywoo-

    You're a Goodun!X


I love comments! All bloggers do! If you have something to say, agree or disagree I would love to hear it! I will reply to all! (or try my very best!) If however, you're a troll, save your breath!

Due to an increase in spam I moderate comments but ALL genuine comments will be posted. See above exclusions!