COPD/Bronchitis and "feeling hot"

[FiremedicMike]

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We had a regular yesterday, first thing in the morning. She's a COPDer, calls regularly when she gets out of hand. Usually she just wants a nebulizer from us and doesn't want transported. Well yesterday she started at diminished and 85%, after first round of albuterol/atrovent she's still diminished and only 92%. I convince her to go, IV decadron, no big deal. Throughout assessment and transport, she keeps saying she feels hot, fanning herself, etc.

Fast forward 14 hours, she calls from home at 0100 with another flare up. Says she was diagnosed with bronchitis and given prednisone which she opted to wait until tomorrow to take. This time the treatment clears her up "enough" and she vehemently refuses transport. Again she's complaining of f
"feeling hot".

Is there any significance to the whole "feeling hot" thing?

On an unrelated note, I saw an 11 year old on palliative care with pelizaeus merzbacher disease, that was nice and depressing.

 

[deleted109597]

Feeling hot is what laypeople say when they think they have a fever. Sometimes.
It really doesn't mean anything.

 

[FiremedicMike]

She was afebrile..

I don't mean to ask this question like an idiot, I've been doing this quite awhile now and never seen a COPDer act like that. I was just wondering if there was any clinical significance to it.

 

[WilcoWorld]

Two thoughts:

1 - Perhaps that was her perception of a hyperadrenergic state induced by her active COPD + a whole lotta beta agonist?
2 - What McNinja said.

 

[MrsOfficer]

Throughout assessment and transport, she keeps saying she feels hot, fanning herself, etc.

Fast forward 14 hours, she calls from home at 0100 with another flare up.

I'm not trying to be snide by any means, but was she anywhere in the possible age realm of menopause? Sure sounds like it could just be hot flashes... with uncomfortable timing.

 

[FiremedicMike]

Two thoughts:

1 - Perhaps that was her perception of a hyperadrenergic state induced by her active COPD + a whole lotta beta agonist?
2 - What McNinja said.

I did not think of the beta agonist, she had sucked down her own nebulized albuterol prior to our arrival, followed by our two combo treatments. I suppose that certainly makes sense, it just struck me as odd because I hadn't seen a patient complain (several times) of feeling hot, even after multiple breathing treatments. And that this complaint was consistent with both runs which were ~14 hours apart.

As for McNinja's statement, I'll just have to differ to the experiences that you both have had, it has been my experience that febrile people complain of being cold and request to be covered up as opposed to fanning themselves. But again, it is pertinent to mention I did not notice any abnormal warmth to her skin throughout the assessment.

I'm not trying to be snide by any means, but was she anywhere in the possible age realm of menopause? Sure sounds like it could just be hot flashes... with uncomfortable timing.

I don't take your response as snide at all, I appreciate the interaction here. To answer your question, she was in her 70s, so no.

 

[Dwindlin]

If you were giving ipatropium with the albuterol maybe anticholinergic effect?

 

[dchristismi]

As for McNinja's statement, I'll just have to differ to the experiences that you both have had, it has been my experience that febrile people complain of being cold and request to be covered up as opposed to fanning themselves. But again, it is pertinent to mention I did not notice any abnormal warmth to her skin throughout the assessment.

Ah, but what he said is that people *say* they feel hot when they *think* they have a fever. We hear this all the time, and they're rarely febrile. They also rarely have thermometers or actually checked their temperature...

And you're right - the truly febrile often feel cold - that would be the shaking chills/rigors.

I'm going to vote with the others: adrenergic surge + B-agonists, but not worry about it. Could have also been a near-vagal reaction, but you'll probably never know.

 

[Groove]

I wouldn't read much into it. Gotta tease out the truth many times as pt's aren't great at explaining their symptoms.

Hell, she could be a COPD'er in menopause for all we know with hot flashes. Who knows. My pt's tell me they haven't seen their doc "in a minute" which could mean 60 secs to 6 months to 6 years and anything in between.

Gotta tease it out.

 

[BF2BC EMT]

I wouldn't read much into it. Gotta tease out the truth many times as pt's aren't great at explaining their symptoms.

Hell, she could be a COPD'er in menopause for all we know with hot flashes. Who knows. My pt's tell me they haven't seen their doc "in a minute" which could mean 60 secs to 6 months to 6 years and anything in between.

Gotta tease it out.

Haha so true about "in a minute"