Serene Forest

Tuesday, December 3, 2013

When to Call For an Ambulance

Hello All,

I continue to do well and have been able to be more active after stopping my supplements. I believe they were making my system more acidic. I have now become more balanced. It is still very clear, however, that no matter how much better I feel; I still have exercise intolerance and permanent muscle weakness. I must continue to use oxygen, eat a pH balanced diet, stay hydrated, get enough sleep, avoid my triggers, use my power wheelchair, and rest as much as possible (all day). I must continue to “walk the tightrope”.

This morning I received a link to a group who is writing a book about “harm in the Emergency Room” (ER). They are collecting as many stories as possible of people who have received mistreatment in the Emergency room. They hope to stop it. If anyone would like to share his or her story you may go to:

I decided that today should be the day I share my experiences in the ER. I will do this in three parts over the next three days. Today I will discuss when to go to the ER. Tomorrow I will discuss avoiding the pitfalls in the ER and the third day I will tell of my experiences in the ER.

When to call an ambulance or go to the Emergency Room if you have Periodic Paralysis

After studying Periodic Paralysis and Andersen-Tawil Syndrome, I have learned that an ambulance does not need to be called every time I become paralyzed. When I have an episode of paralysis, I will usually be fine in a few hours. However, if I have trouble with my breathing, my heart or with choking or swallowing, then an ambulance may be necessary.

I want to add here, that an important reason for going to the ER, if a person does not have a diagnosis, is to get the attacks documented, a "paper trail" is often needed. Proof of the episodes must be established.

The following is written about Periodic Paralysis in relationship to the need to call for an ambulance or to go to the emergency room:

Go to the emergency room or call the local emergency number (such as 911) if you faint or have difficulty breathing, speaking, or swallowing. These are emergency symptoms.

In more serious cases, the swallowing or breathing muscles may be involved.

When dealing with hyperkalemia, high levels of potassium, the following may be helpful. I have been told, if the level is 6.0 or more than emergency treatment may be necessary:

The following is a guideline for hyperkalemia:
Hyperkalemia is a medical condition of elevated bloodstream levels of potassium. While the normal blood potassium level is 3.5-5.0 mEq/L, mild hyperkalemia can be between 5.1-6.0, moderate between 6.1-7.0, and severe above 7.0. In an extreme case, hyperkalemia can be an emergency as the condition may lead to fatal effects.

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of hyperkalemia. Emergency symptoms include:
Absent or weak heartbeat
Changes in breathing pattern
Loss of consciousness

More serious symptoms of hyperkalemia include slow heartbeat and weak pulse. Severe hyperkalemia can result in fatal cardiac standstill (heart stoppage).

Mild hyperventilation is a symptom of hyperkalemia due to metabolic acidosis.

Symptoms of hyperkalemia include abnormalities in the behavior of the heart. Heart abnormalities of mild hyperkalemia (5.0 to 6.5 mM potassium) can be detected by an electrocardiogram (ECG or EKG). With severe hyperkalemia (over 8.0 mM potassium), the heart may beat at a dangerously rapid rate (fibrillation) or stop beating entirely (cardiac arrest). Patients with moderate or severe hyperkalemia may also develop nervous symptoms such as tingling of the skin, numbness of the hands or feet, weakness, or a flaccid paralysis, which is characteristic of both hyperkalemia and hypokalemia (low plasma potassium).
When dealing with hypokalemia, low levels of potassium, the following may be helpful.

Mild hypokalemia is often without symptoms, although it may cause a small elevation of blood pressure,[2] and can occasionally provoke cardiac arrhythmias. Moderate hypokalemia, with serum potassium concentrations of 2.5-3 mEq/L, may cause muscular weakness, myalgia, and muscle cramps (owing to disturbed function of the skeletal muscles), and constipation (from disturbed function of smooth muscles). With more severe hypokalemia, flaccid paralysis and hyporeflexia may result. There are reports of rhabdomyolysis occurring with profound hypokalemia with serum potassium levels less than 2 mEq/L. Respiratory depression from severe impairment of skeletal muscle function is found in many patients.
Some electrocardiographic (ECG) findings associated with hypokalemia include flattened or inverted T waves, a U wave, ST depression and a wide QT interval.

Hypokalemia is defined as a potassium level less than 3.5 mEq/L.
Moderate hypokalemia is a serum level of 2.5-3 mEq/L.
Severe hypokalemia is defined as a level less than 2.5 mEq/L.

Cardiac arrhythmias This phrase is used to collect a group of different conditions where the heart has abnormal electrical activity. It does not mean that the heart beat is irregular, although it can be, it can also be regular. The speed of the heart beat may be either fast or slow as compared to normal. In some cases of cardiac arrhythmias, they can be medical emergencies and a life-threatening situation.

If an individual has Andersen-Tawil Syndrome (ATS), they experience episodes of paralysis based on low or high potassium levels or there may be episodes in normal ranges. Those with ATS experience serious ventricular arrhythmia with the possibility of life-threatening long QT interval heartbeats. They must be monitored closely. They may experience any of the above symptoms, especially, trouble with breathing, with the heart or with choking or swallowing. If these occur then an ambulance may be necessary.

However, it is best to be prepared with the emergency chart posted in:

It is imperative for one with Periodic Paralysis to know the above information and to have this important information written and handy in case an ambulance must be called. I keep this information in a plastic folder along with everything I know is important and that the paramedics and EMTs must know when coming to my aid in an emergency and for the doctors when I get to the hospital. I approach it as if I will have no one with me to explain my needs. I keep it near the door and take it with me when I leave home.

Tomorrow:  Avoiding the pitfalls of the emergency room 

Until later...

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