A Different Kind of Difficulty Breathing
Three or four times each shift, we respond to calls for difficulty breathing. Along with chest pain, this is the most frequent condition we encounter.
Usually, the patient suffers from a chronic respiratory disease, such as asthma or emphysema. Sometimes the patient’s heart has failed, causing fluid to back up into the lungs. Tonight, though, we handled a breathing problem of a different type.
The patient was close to 100 years old. She’d lived alone in the same apartment for more than six decades. Early this afternoon, as she passed through the kitchen, she bumped against a knob on her stove. She sat in her living room until dinnertime, watching television for nearly six hours as her home filled with natural gas. All things considered, she was fortunate not to blow herself up.
By the time her son came over for a visit, the woman was gasping for air. He threw open the windows, but his mother doesn't get around well, and she was too heavy to carry. He couldn’t get her out of the house.
We arrived to find her seated on the bed. The room still smelled of gas. I listened to the woman’s chest. For some reason, her lungs were filled with fluid.
“Can breathing natural gas cause you to go into pulmonary edema?” one of the EMTs asked when I reported what I’d heard.
I had to admit that I had no idea. The big danger with natural gas, of course, is the risk of explosion. I’d never encountered a patient who’d inhaled natural gas for a prolonged period.
I deferred to my partner on this. “I’m not sure about pulmonary edema,” he said, “but it can certainly asphyxiate you.”
Then came another wrinkle. When my partner explained the situation to the son, the son said, “Her nurse was here yesterday and said her blood pressure was low. She told my mom not to take her blood pressure pills any more. Could that have anything to do with it?”
Most definitely, we told him. In fact, it was probably the lack of blood pressure medication, more than the gas, that was causing the difficulty breathing.
We carried the woman to the ambulance. On the way to the hospital, we started an IV. I gave her an injection of Lasix—the same medication that was supposed to be controlling her high blood pressure, until the nurse stopped her from taking it. She improved greatly in a matter of minutes. She arrived at the emergency department in great spirits, talking to us about the weather.
In a sense, this was an ordinary call. It was a case of congestive heart failure, something we see four or five times each week. What made the whole thing interesting was the gas leak. That added a challenge to the diagnosis. Plus, it made the situation somewhat bizarre. I mean, let’s face it—emergency or not, there’s nothing terribly interesting about an elderly woman getting sick. But an elderly woman who fills her home with natural gas for an entire day, and survives to get sick from an unrelated problem? Well, that’s not something that happens all the time.