By Brenden M. Wetherton, MD, MS, FACEP
It never fails that injuries and pains happen at inconvenient times and then the pressing question exists. “Should I go to the ER?” Adding insult to injury, its11 o’clockat night, Sunday afternoon, or your primary doctor is out of the office. Remember that primary care physicians typically have an on-call service and can answer questions over the phone and guide therapy. Poison Control is an invaluable nation-wide resource and can be contacted 24 hours a day at (800) 222-1222 and can guide therapy and potentially save an ER visit for benign ingestions.
So let’s address the above burning question, should I go to the ER. First, what are the most common reasons patients go to an Emergency Room? Most visits are related to injuries (falls, car accidents, cuts, strains, and contusions), HEENT (head, eyes, ears, nose, and throat), skin (rashes), abdomen pain, lungs/chest pain, and urinary complaints. This is far from an exhaustive list of reasons to go to an ER but should address most of the common concerns.
Injuries are common in all age groups. You should be more cautious about injuries in children less than 2 and adults greater than 60, people who take blood thinners, and those injuries around joints with significant swelling and limited movement. Cuts and injuries especially around the feet and hands can cause long-term problems and typically require urgent treatment. Falls associated with neck and back pain also require more immediate attention.
HEENT (head, eyes, ears, nose, and throat) complaints include things such as headaches, red eyes, strep throat, and nose bleeds. A headache that is described as the “worst ever,” a change from typical behavior, or one associated with repeated vomiting, weakness, fever, or neck pain require urgent evaluation. Any eye pain associated with visual changes (blurry, double, or loss of vision), injury to eye, or chemicals in eye can all lead to long-term damage and should also be evaluated. People with nose bleeds that continue after 20 minutes of good constant pressure on the nose or sore throats with difficulty swallowing, facial/tongue swelling, or difficulty speaking all should consider going to the ER.
Skin complaints are other common reasons that people present to the ER. Rashes related to an allergic reaction, spreading redness of the skin from a wound, and rashes associated with fever can signify a severe illness. Bite wounds typically involve skin infections and warrant urgent treatment and follow up.
Abdominal complaints are common in all age groups and can be caused by some life-threatening illnesses. Any sudden pain and those associated with intractable vomiting and diarrhea should be evaluated, as well as anytime blood appears in the vomitus or diarrhea. Patients at high risk for severe problems are those with recent abdominal surgery, right lower sided pain, history of diabetes, and the elderly.
I will discuss lung and chest complaints together. Most chest pain deserves a call to the primary doctor if not a visit to the ER. Patients older than 35 years of age, especially with sudden onset of pain, associated with shortness of breath, fainting, and left arm pain should be evaluated urgently. Most cases of cough and cold symptoms can be seen by the primary physician but those with the addition of shortness of breath, sudden onset, wheezing, and fever should be evaluated.
Lastly, urinary complaints associated with fever, vomiting, blood in the urine, or extremes of age should be seen earlier because these can be associated with more complicated illnesses. Again this is not an exhaustive list but hopefully gives some information of the symptoms that might require a visit to your local ER. Please stay safe but we are here if you need us.
Brenden M. Wetherton, MD, MS, FACEP is the Medical Director of Jewish Hospital Shelbyville, East and Northeast.