Free Memoirs of an Emergency Nurse by Elizabeth Nicholl

tightening and blocking the air getting in, the inability to speak because of gasping for oxygen and the progressive dangerous exhaustion that take s so much energy out of the patient they are just too tired to carry on breathing and fighting the foreboding feeling that they might die .
    With many things in e mergency , a change in the weather means a change in the number of patients . It was a rainy morning in spring but really muggy too after a few days of sunshine . Anna was an asthmatic and in her late twenties . She was brought into emergency by paramedics . Her breathlessness was clearly audible over the noise of people talking , with a raspy wheeze on expiration and inspiration , every breath she took. The paramedics had given her several nebulisers on the way in . The nebulisers were sachets of liquid S albutamol put into a collection pot running through a set of oxygen tubing.
    The S albutamol opens the lungs to allow for more oxygen to be used, however , it doesn’t reduc e the constricted swelling in the airway , which is the main cause of asthma and has a side effect of tachycardia. T he nebuliser was steaming loudly as high flow oxygen went through the drugs , making it bubble in the collection pot and steam out of the face mask . Anna was a large lady with long brown hair and she was in her nightdres s . S he had been woken with an asthma attack and had little time or energy to get dressed prior to the paramedics arriving . She was red face d and clammy, her whole upper body moved with every strained breath she took, clearly using all her accessory muscles to help suck air into her lungs . Strands of her long hair were plastered over her forehead and she made no effort to move it away from her eyes, indicating a lack of energy to do anything but concentrate on breathing .
    We transferred Anna onto the trolley , keeping her in as upright a position as possible to assist her breathing , and then we unhooked the portable oxygen to the oxygen on the wall . She was so out of breath she couldn’t move her legs over onto the bed next to her and so we use d the pat slide to quickly get her across . We had had a warning telephone call from the paramedics so Anna was expected and we all knew the possible outcomes . She had stopped breathing on many occasions because of her asthma and was well known by the medical teams . She was a regular for being intubated in intensive care and that is probably why she called the ambulance as soon as the attack had started .
    She was literally gasping for breath ; it was a slow controlled breath in and a slow breath out with a loud wheeze . A s I listened to her chest with the stethoscope , it sounded like she was breathing through a loud speaker . H er airway was so tight I could hear what sounded like a large gentleman snoring with a whistle at the end of each breath . The air desperately trying to get through her narrow airway caus ed the whistle . T here was no way we could attempt a peak flow measurement as she needed every breath .
    We could tell Anna was bad and we didn’t need a measurement for that. She was extremely anxious. I’d measured her oxygen saturations via a probe on her finger and it measured something in the eighties. The average measurement of a normal reading in a non-smoker would be above ninety six percent. The doctor had asked for back-to-back nebulisers and we continued giving the drugs to open up her lungs so that oxygen could get to them.
    Anna was sat nearly bolt upright and her whole chest was moving, trying to get air. Her belly rose and fell with each big gasp and her chest muscles expanded with each inspiration. She was scared. She was well aware of how bad her asthma was and of her past experiences of being intubated and waking up in intensive care, wondering if she would survive. She took hold of my hand. Between the breaths was a loud moan and I tried to reassure her. I was talking close to her ear, steady and slow, reassuring words. While she was