When people say shortness of breath as a symptom what do they mean exactly, what are you seeing in the emergency room?




Answered by Dr. Erin O'Connor, Deputy Medical Director, Emergency Medicine, UHN and Nicole Harada, Registered Nurse and Patient Care Coordinator, Toronto Western Hospital.
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Question:
When people say shortness of breath as a symptom what do they mean exactly, what are you seeing in the emergency room?

Answer:
Shortness of breath it depends on each individual kind of experiences does it differently. With you know severe shortness of breath it's very noticeable when you are at rest you can notice that you are breathing a lot faster you might have to use more muscles to kind of take a deep...

[Transcript copy is verbatim per the video]
Original air date: April 23, 2020. Information shared in this video was current at time of original broadcast.

Nicole Harada:
Shortness of breath it depends on each individual kind of experiences does it differently. With you know severe shortness of breath it's very noticeable when you are at rest you can notice that you are breathing a lot faster you might have to use more muscles to kind of take a deep breath and you just don't feel like you can get a full breath. Other in other scenarios it might be you know you're walking somewhere where you normally walk and all of a sudden you are finding I'm really out of breath so that's another way to kind of keep an eye on how you are breathing. And in the emergency room it's a combination of anywhere from you know they really can't catch their breath and their breathing very shallow too you know it just doesn't seem quite right I just feel like I can't quite catch my breath. So it really depends.

Dr. Erin O'Connor:
So it's interesting with COVID patients as opposed to many other patients who present with respiratory distress, they are alert and awake and still able to talk the breathing heavily but their oxygen saturation which is a percentage from zero to 100% though I have to say I've never seen a zero and a lot of patients but most people are around 97 to 100% oxygen saturation so the level of oxygen in their blood and we get concerned usually when people are under 90 you know that's considered more serious we put oxygen on and many of these patients are coming in still alert and awake and talking but with saturations in the 50s or the 60s which is in my experience in emergency medicine and in other critical care medicine I haven't actually seen most people are not at that stage alert and awake and talking they're very sleepy very drowsy and it's a very different situation that we're all facing and this has been reported in other centers as well. And coming up on a lot of the emergency medicine blogs and case for studies and that kind of thing. So we I've had a few patients who have come in with SATs like that and what we do is we put them on a full oxygen mask but we have to be very careful because at higher volumes of oxygen there is the chance that people will aerosolize so that droplets will become fine droplets with virus and them and then get out into the air so we have to be very careful and change our PPE so that we're wearing the more advanced sort of PPE in that situation. And with these patients what we're seeing is that their oxygen saturation will go up a bit but it won't come back to normal even with these really high volumes of oxygen and then we move to the decision to intubate which is when we give patients medication to make them sleepy and unaware of what's going on and we insert a breathing tube into their lungs and then have a machine breathe for them and it allows for people to have their lungs rested a bit and to make sure that we're giving as much oxygen as possible and to change the pressure which we're giving oxygen to allow a more efficient spread of oxygen into the bloodstream, and so that goes through we go through a consenting process with the patient if in in these situations we're talking in the patients directly usually we're talking to family members by that stage but we're talking to the patient letting them know what the pros and cons are and what they're going to go through. And then usually I try to at the very last minute before I give them sedating meds you know reassure them that they're in good hands and that we'll see them soon and that we're going to take good care of them it has to be frightening and it's a situation where they're just seeing me and my mask and my kit and not their family members and so we try it as much as possible to to make a human connection at that moment as well. We have a team of people around that do that and we get vacation and then we insert the breathing tube now with these patients we're finding that at the moment we give them the medication their oxygen saturation levels drop rapidly very rapidly more than we were usually seen so it really does take a very skilled person to be able to do this appropriately and so we've worked on strategies around that at UHN to make sure that we're giving the best care to these patients.

[Transcript copy is verbatim per the video]
Original air date: April 23, 2020. Information shared in this video was current at time of original broadcast.



Answered by Dr. Erin O'Connor, Deputy Medical Director, Emergency Medicine, UHN and Nicole Harada, Registered Nurse and Patient Care Coordinator, Toronto Western Hospital.
Click to learn more about UHN or to DONATE NOW

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