Post-ICU Migraine Crisis: Two Trips to the ER
In this Part 1 of 2 series, I talk about my awful experience in the ER, what lead up to me being there and what I continue to learn, as this crisis is still in an active state, but I have remained stable enough to be home and receiving home health care.
[I'll do my best to avoid the scary moments to avoid triggering any readers, as this is not the first time I had experienced anaphylaxis, but I certainly hope it is the last. I also talk about lack of IV access, leading to a midline & a PICC line, and lots of emeses (vomiting)].
Going to the emergency room for a reaction
Recently, I was in the ICU for a reaction to a medication administered by a doctor outside the hospital in a clinical setting. Unfortunately, within minutes, I was in a major crisis, in anaphylaxis, being escorted by EMTs to my "home" emergency department after not responding well to the first Epi-pen used. The ride to the ER felt like a long time. My hospital of preference was only 10-15 minutes away, but I was in and out of it the whole way there. We eventually arrived at the hospital, and the next thing I remember is a lot of people in a tiny room yelling for medications, and I sensed anger in the air as they could not access my veins with an IV - all attempts failed. So, they placed a midline in the only artery they could see with their equipment that was accessible at the time. It hurt, but there was no time to put topical or injectable anesthetic to the area of my inner bicep where it was inserted. They wasted no time, and within a matter of seconds, I was being hooked up to multiple machines and oxygen.
Just when the ER staff thought I was stable enough to try sitting up, I began to have another obstruction in my airway. I was immediately put on an IV drip of epinephrine, just as I was given another shot of epinephrine in my arm. I faintly overheard a doctor say that I was going up to the ICU to be admitted to cover all bases and figure out what was going on.
Going home and coming right back
After a few short days of being stabilized and seemingly "good to go," I left the hospital, only to be admitted again within 2 days of leaving. This time, I didn't come back with anaphylaxis, but rather a health crisis that left me completely dehydrated, malnourished due to my history and current state of Crohn's disease and the medication I had received the day the ambulance drove me to the emergency room. Oh, and skull-crushing headaches.
I presented with a myriad of symptoms, but mainly a high number of incredibly scary spells of syncope, loss of consciousness, and severe nausea and vomiting. Quickly, my head began to hurt so bad I could barely utter the words and my medical history to anyone that would listen. Due to the state of my veins and my very poor history of not being able to be accessed, they tried to give me meds through the midline they had inserted in the ER a few days prior, only to find out it had clotted and needed to be removed immediately. I sat in the ER, puking blood and bile for 2.5 hours before someone came to tell me that I was being readmitted, as they had no idea as to what was going on with me.
An excruciating migraine attack
Meanwhile, I had a migraine that was a full-blown 12/10 - I honestly don't remember having a migraine that bad, puking and still feeling as awful as ever. I tried swallowing Tylenol and ended up puking up even more than I had before. I was angry - that no one had listened to how bad my pain was, how awful my nausea was, and that I was left unattended for 2.5 hours screaming for help, with no one coming. The first time I actually saw someone for the first time in hours was a doctor who popped in for TWO seconds and said, "Don't know what's wrong with you, so you're being admitted," and promptly shut the door. As I lie there, in the ER - vomiting blood and bile, alone because of COVID-19 precautions, I begged for something for my migraine. At one point, I remember vomiting as I begged for a shot of Toradol. The nurse that was nearby said, "Maybe we can get you something once you're admitted, but I can't approve that now."
Still, to this day (only a few weeks have gone by), I'm irate when I think about the lack of care I received. Was it because I "just" presented with syncope and nausea that quickly turned into a migraine? I will honestly never know, but I know that it's common knowledge that ERs & EDs don't hold up the best to be in best practice for migraine patients.
Getting a PICC line put in
While my veins are still being shotty, and my midline they inserted due to more access issues to start an IV, I was quickly whisked away to get my midline out and stitched up and a new PICC line put in. For those unaware, a PICC line stands for a peripherally inserted central catheter. They are often utilized for patients who consistently get IV medications and have severe trouble being accessed due to poor veins/arteries, scar damage/tissue, and other health reasons.1 I think the only moment I stopped vomiting was the few minutes I was in the sterile interventional radiology room with a barf bag close to my face & being told if I need to vomit, let them know immediately (or the whole procedure would fail).
After about 10-15 minutes and my PICC line being sutured in, I left that sterile room and immediately filled the bag up to the top. I kind of wish I would have been able to hand that to the doctors and nurse that were questioning my symptoms 3 hours before. Normally, I'm extremely kind, understanding, and patient when it comes to medical settings, but to be neglected when it felt like I had a brain bleed and was vomiting blood set me off. Still, though, I somehow remained composed. I think I honestly didn't have the energy to be anything but lying there.
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