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» You saved his life Dr. Mallon and Dr. Herbert….

You saved his life Dr. Mallon and Dr. Herbert….

Yesterday I had the gut-wretching experience of caring for that asthmatic you all talk about.  He was the patient you have dedicated so much time to teaching us about.  In over ten years of EM practice, I have been blessed enough to almost consider the crashing asthma patient a myth.  The only patients who did die were basically dead when they showed up at the ED.  I had yet to encounter the asthmatic that walks in but goes downhill despite timely and aggressive treatment, but because your great teaching I felt like I had seen it a dozen times before.  This, of course, did not reduce the stress or severity of the situation.

He was a young, mostly health, patient who had reactive airways disease that not only failed to turn around, but got worse and worse despite aggressive and appropriate treatment.  He was 15 years old and initially arrived looking like the millions of other wheezy kids that turn around with a couple of breathing treatments and a dose of steroids.  However, he was not one of those other kids.  He was one of the patients you warn us about and teach us how to deal with.  He got worse and worse, despite albuterol, atrovent, more albuterol, more albuterol, then magnesium, terbutaline, xopenex, etc.  Ultimately I had to make the gut wretching decision to intubate him, and followed Dr. Mallon’s advise to administer ketamine after intubation.  He did not turn around immediately, but it halted his downhill course.  He ended up surviving and doing well. 

It is not often that I feel the entire weight of my life and death decision the way i felt it with this kid.  Fortunately, i also felt the security of knowing what the experts in my field do and recommend in this  scenario.  I could hear Mel Herbert’s EMRAP voice and Dr. Mallon’s didactic sessions every step of the way.  Of course the mother was extremely appreciative to all of us, consdering her son was clearly on death’s door.  They may not realize it, but that kid and his mother owe a debt of gratitude to you guys as much as they do to any of us in the ED caring for him last night.  So do I.  I can sleep at night knowing he is safe and with his mother.

122 Responses to “You saved his life Dr. Mallon and Dr. Herbert….”


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