"Not only did the FirefighterAid help my family while I was in a coma, they helped me recover back to my job with full, caring support. No one knows what the FirefighterAid is truly capable of until you are in real need for help. I can not imagine my recovery with out them. YOU GUYS ARE ANGELS. THANK YOU!"
- Dre Dominguez
Her incredible story is significant not just because of our chance encounter, but also because a team of dedicated pulmonologists refused to give up while resuscitating her. The team of specialists made a decision to place Dre on an extra-corporeal membrane oxygenation (ECMO) unit, a highly sophisticated bypass machine that they had never used before on a critical asthma patient. Their decision and Dre’s strong will to survive saved her life.
Dre spent the two weeks prior to her medical crisis feeling a little under the weather. She had a bit of a cough, felt a little sleepy and, at times, felt some heaviness in her chest. She brushed it off as a slight cold. Working in a busy, multi-apparatus fire station, it seems that someone on shift is always fighting illness. So Dre thought it was simply her turn. Even while feeling sluggish, however, she kept up all her normal activities. She even participated in the “Fight for Air” firefighter challenge, which includes climbing 31 stories in the San Diego Omni hotel as a fund-raiser for the American Lung Association.
The morning of March 9th, Dre arrived at work feeling more rundown that usual. Before she had time to focus on herself, she was dispatched on a medical call. At the scene, she began to realize she was more than just a little run down; she was struggling to breathe.
The SDFD ALS engine 1 crew immediately took Dre aside and began to assess her vital signs. Her oxygen saturation (SpO2) was in the low 90s; she had tight, wet, junky, diminished lung sounds and flushed skin. They offered to work her up right there and transport her to the hospital, but like most emergency responders, she was more concerned about the primary patient and said she would go see her primary physician after the call.
She signed off shift and went home sick. Once at home, she realized this was no ordinary asthma attack; she was getting progressively worse. She was dyspneic on exertion and seriously “tripoding.”
She finally gave in and asked her roommate to drive her to the emergency department (ED) of Sharp Memorial Hospital. This is where the story of her survival takes an amazing, unexplainable turn. The ED near her home, and in her normal response district, is fantastic. She knows everyone there by name and is completely comfortable there. Yet, in a strange twist of fate, she asked to be taken to the Sharp Memorial Hospital, where they do heart transplants and other extraordinary medical and surgical procedures with equipment and devices not found in other hospital facilities. This was just one in a string of extraordinary events that led to her remarkable care and survival.
Dre experienced two additional unusual occurrences before she reached the medical team at the ED. When she arrived at the hospital, no ambulances were parked at the ED entrance and no patients were waiting in the waiting room. From her past experience as a paramedic, she knew that happens as often as Haley’s Comet.
She arrived weak, dyspneic, flushed and with a heart rate of 100. Over the next two hours, she was given at least nine breathing treatments and Benadryl. Despite the constant treatment, however, her condition continued to deteriorate.
Dre’s friend, a seasoned paramedic, was there by her side every moment and knew that it was going to be bad. Dre’s friend became even more concerned when Sharp pulmonologist Richard S. Sacks, MD, walked into the room. He exuded a commanding presence and gave several simultaneous orders to staff, including ordering continuous positive airway pressure (CPAP) and Dre’s immediate transfer to the intensive care unit (ICU).
Once his firm orders were presented to the ED staff, Dre’s friend remembers that Sacks personally began to focus 100% of his attention on Dre, explaining his thoughts on why Dre was deteriorating and telling her what the Sharp team would be doing to attempt to turn her condition around.
CPAP was applied, but it didn’t give her any relief—nor did bi-level positive airway pressure (BiPAP). By now, she was consistently presenting an accelerated heart rate of 170 and a blood pressure of 200/100. She was placed on Solumedrol and was now fighting to breathe.
Sacks then told Dre she was going to be intubated. She knew what that meant and initially refused. So a small table and pillow were placed in front of her to facilitate a tripod position. Once her head started bobbing and her stare became vacant, she was told it was time for a tube. Dre’s reply to her friend was, “Please don’t let them intubate me. I won’t come back.” She remembers experiencing an overwhelming feeling of impending doom.
Another Sharp pulmonologist, Thomas E. Lawrie, MD, performed the intubation with several of Dre’s medic friends present. Dre was intubated via rapid sequence intubation. Lawrie successfully intubated with an 8.0 tube and no issues. When the pulmonologist began to dial in the ventilator settings, however, trouble occurred. Dre wasn’t taking to the vent at all.
Dre’s friends recall the next 90 minutes of heroic efforts by Lawrie—making adjustments, intermittently bagging her and performing forced exhalation to raise her SpO2 levels, which soon plummeted down into the 40s.
It was determined that after CPAP and BiPAP, Dre had lapsed into status asthmaticus. She continued to try to breathe against the tube but could not. But he refused to give up on his efforts to calm her down and enable her to breathe.
Dre then began to develop extensive subcutaneous emphysema. She soon had no distinguishable facial features; she was swollen down to her toes. But there was no actual pneunomothorax present, just overwhelming intrathoracic pressure that was inhibiting her ability to breathe. The decision was made to put her on heliox, a blend of helium and oxygen at a 60/40 ratio, in an attempt to decrease that pressure. That treatment was started, but Dre’s condition continued in a downward spiral.
Medically, the worst appeared to be over for Dre, but mentally, it had just begun. After days of heavy narcotics and sedation, she began to feel the effects of withdrawals. She was diaphoretic and began to vomit out her NG tube. This caused anxiety-induced chest pain that she described as getting hit by a truck, or having a myocardial infarction.
The staff tried to use fentanyl and zofran to help with the pain and her nausea; they ended up putting her on a propofol drip, hoping she would relax and sleep. After two days of what Dre described as horror, she asked to have all meds stopped. As her athletic background and training began to kick back in, she began to rebound physically and mentally. She felt after all the meds had worn off that she had to reconnect her brain to her body.
She was released from the ICU 24 hours later and started on a regiment breathing treatments and extensive physical therapy to help her sit, stand and walk. This well-conditioned firefighter/paramedic and athlete found it extremely exhausting just to walk from her bed to her chair.
Her mother was told to expect 60 days in the hospital and 60 days of physical therapy. But this gifted athlete was out in just 12 days and back on the job in four months. She was put on lovenox and coumadin for one and half months to help with clots to her arm and neck, as well as prevention for future risk of pulmonary embolisms.
Dre still has occasional periods of memory loss and stumbles on her words, but she considers these complications minor, and they don’t interfere with her profession or personal activities. Dre knows that at any point, it all could have turned on a dime. While talking about all of her activities and accomplishments, she said, “I never waited for a tragic event to start living my life.” She would have been at peace if she had died, knowing she had accomplished so much and meant the world to so many people.
Lucky for Dre and all of us she is healthy and well and back to work and supporting FirefighterAid in her spare time. We are so amazed by her strength and stong will!
DRE DOMINGUEZ PRESS LINKS:
3/9/2016 - Paramedic Survives Severe Asthma Attack