Try this at home

I was called at 6 in the morning to admit this old man to the ICU because he couldn't breathe. The ER doctor was very concerned because he was having angioedema.
Angioedema is a very rapid swelling of the throat which usually results from an allergy. This man started to take a new medication a day before that he was allergic to, so his neck swelled up in a few minutes and he came to the ER.

I went to see him. He could not talk at all, his tongue and the entire neck were massively swollen. He tried to speak but no words came out. The biggest concern was for his throat to completely close up and he would then stop breathing. That was a matter of time, probably a few minutes.

To prevent him from dying we had to make a big hole (called tracheostomy) in his neck to allow him to breathe. Cool. The only problem is that I don't know how to make this hole, I've never done it and never will, I'm not trained to and I'm not officially supposed to. I turned to the ER doctor and asked him about it, and I could see him almost shitting in his pants because he didn't know how to do it either. We had to call the specialist and bring him from home to do it. That would usually take at least half an hour to do and by then the patient would be in heaven singing with angels.

We gave the patient a bunch of medications and we were hoping they would still work. We gave extra doses of each medication and still waited to see some improvement. Time passed and the old man started to breathe better... good, then he started talking and that was great. An hour later he was able to speak well so by the time the surgeon arrived to the hospital in his pyjama there was no need to stick a knife in the man's throat.

The old man told me the story

"I woke up with this pain in my neck. I couldn't move it and I felt I was losing my breath"

"So did you call 911 for help?"

"No, I couldn't speak, if I called them what the hell was I gonna say, I couldn't say anything"

"Well sir if you would have called 911 and you didn't say anything they will locate your address and come in to your place"

"Oh, I didn't know that!"

"Ok so what did you do, how did you come in to the hospital? Did someone drive you here"

"No, I drove myself, but I didn't know the address to the hospital, it's been a long time since I've been here"

"Did you drive here while you were out of breath"

"Yes I had to, I didn't find another way, the problem is that I forgot how to get in"

"What did you do?"

"I stopped by a couple who were jogging and asked them for directions"

"But you couldn't talk....."

"That's right, but I had a pen, I wrote my questions down on a piece of paper "How do I get to the VA Hospital?"

"Wow...."

" ....but the couple did not the address, they told me it's in the South but they didn't exactly where. "

"So what did you do? Did you ask other people?"

"No, it was 5 in the morning and the street was empty, so I went back home and checked the address on the internet and got in here"

"where you out of breath all this time?"

"Yes, I felt I was gonna die, but I had to do something"

"If this happens next time, call 911 immediately and they'll come pick you up"

"What if they I didn't have a phone around?"

"We will give you allergy needles, if you couldn't breathe grab one of these needles and inject yourself with them until you get to the hospital"

"What if they did not work"

I thought for a second then told him, "then grab a knife a stick it in the middle of your neck, that's where your breathing tube is located, and this can help you breathe. With all honesty that's exactly what we were about to do in the emergency room"

I was waiting for him to ask ,"what if there was no knife around" but he didn't. He seemed to really like the idea of stabbing his neck with a knife.

He did well overnight and we discharged him home the following day.....

I just hope that he doesn't come one day to the ER with a knife sticking out of his throat and him wiriting on a piece of paper , "this is not working, what should I do now?"