almost had it ... part 1

I had my 1st asthma attack during my induksi (a.k.a govt servant induction course) 8 years ago. Since then I had on and off attack. Most of it resolved with a sipped of inhaler....but this time - I had the worst ever... I almost had "it"...

I was supposed to do a 6pm-6pm shift. But unfortunately the health insurance office inspection had forced me to come earlier. I started to work by 8 am instead. The morning was ok. By noon, one of the nurse had given me a mango ...then I had my lunch...At 3pm, I was feeling a little bit tightness over the chest. I took a neb of combivent(ipratropium and salbutamol) and it had partially resolved. In the evening, when I took over the ED shift, I was feeling really unwell. I did an oximetry check , my SpO2 was still hanging around 98-99%. The condition got worst when I eaten my dinner. The abd distension sensation had almost " drown me" ... really, I felt that I can't breath !!!!
I went back to the ED, took a neb with the O2 flow. My symptom was partially relieved again - my SpO2 was 97%-98% then. I decided not to stayed in the call room (175). I shifted to the conference room upstairs and rested in the physician office.

Few hours later, I had shortness attack again. I was worried- I am obese and my cholesterol was borderline. I did an EKG 12L with cardiac enzyme and it all returned normal. I did a chest xary and nothing special was noted.  I took loading dose of prednisolone 30mg orally ant did not get better. I then a shot of Methyprednisolone 40mg and after few hours I was feeling better....but still only parital relieved.

I was too tired and took a 1 hr nap between 3-4am. I woke up and did a SpO2 it was 97%...but I feeling severe dyspneic. I went to ICU and asked one of the senior nurse to take a arterial blood gas for me. Since my SpO2 was satisfactory, I was thinking of something more severe : ? acidosis - diabetic induced or maybe HHNK....? ..

I had needle phobia - I really hate being pricked but I need to face and confirmed my thought . Luckily they got it by 1 trial - but the shocking thing came next...the paO2 was only 55mmHg and O2 sat was 88%!!!! although the SpO2 over oximetry was 97%....I knew that I need to go on O2 use.....If I had a patient with such ABG data in the ED, I would have admitted him to ICU...but I was the one doing calls - I can't quit, the second line oncall doctor is a surgeon, he couldn't fully covered the ED...so I need to go on..and I would have to put myself on O2 use...

I went to the ED, locate a empty bed, pulled the curtain and use O2 nc 2l/min. My headache, fatigue, muscle ache went off gradually - I got a good rest of 1.5 hrs before I was disturbed by another ED patient...

By morning, I was feeling better. I was thinking of getting off earlier and told my deputy superintendent. I still had my IV lock on my hand and was thinking of getting another methyprednisolone jab before I went home. But I forget .... and I went home with some oral medication.
I reached home by 9:30am and took my bath. It was 10am when I taken my medication. But I had this shortness of breath attack again - and it was intolerable and Ving was frightened by me...
She offered to sent me to the hospital and got admitted. I resisted a little bit but gave in - I need O2 to recovered from the fatigue of the on call and I was scheduled for another call the next day...

Ving drove me to the hospital and I walked into the ED....The nephrologist was doing my ED shift and he knew what my intention was when I stepped into the ED with the big backpack..... Under the "courtesy" of my senior - I did my own admission and wrote the order. My attending physician was our chest physician( Malaysian as well, he was new ...), he told me to write what ever order I want , he said I should be able to manage....
I really wanted to have a single room but unfortunately the hospital is almost full and I had to share the room with another patient. The worst was - my room mate was a patient I admitted last night. He had a cut over his dorsal surface of his hand and sustained a tendon severence... It was an embarrassed experience getting into my room - multiple explaination to my colleague why I had become a patient... not mentioned the grinned and strange look by my room mate. Actually, I didn't care a shit - all I wanted was an O2 and a good sleep...

I slept for 3 hrs before I was disturbed again by some visitor...I had felt better but my symptom did not fully subsided....

I was confused at that moment - would I recovered or admitted to ICU and I+V (intubated and ventilated !????)