When Should I Go to the Emergency Department?

By Robert H. Couch, MD FACEP

Every day, thousands of Americans are faced with medical emergencies.  People often wonder, am I sick enough to go to the Emergency Department?  We often try to “tough it out” and wait on calling our doctor or seeking care, but that can be a bad idea.

There are some life-threatening conditions that require immediate treatment.  Newer treatments for heart attack and stroke are much more effective if administered early; these treatments may be ineffective if more than a few hours pass by.   Many more lives could be saved if these patients came to the Emergency Department immediately after symptom onset.

TheAmericanCollegeof Emergency Physicians offers a list of warning signs that indicate a medical emergency:

Difficulty breathing, shortness of breath

Chest or upper abdominal pain or pressure

Fainting, sudden dizziness, weakness

Changes in vision

Confusion or changes in mental status

Any sudden or severe pain

Uncontrolled bleeding

Severe or persistent vomiting or diarrhea

Coughing or vomiting blood

Suicidal feelings

Difficulty speaking

Shortness of breath

Unusual abdominal pain

Children requiring emergency care have special needs, and their symptoms may be different from those that adults might experience.  Since very young children cannot verbalize their symptoms, adults must interpret their symptoms.  In general, always get immediate medical attention if you think your child is having a medical emergency.

You are ultimately the best judge of whether or not you need emergency care.  If you believe you need emergency care, go the emergency department. If you believe your condition or your loved one’s condition, is life threatening, or if you believe your condition may deteriorate en route to the hospital, call 9-1-1.  Your local Emergency Medical Services provider is able to come to you and render life saving treatment even before you reach the Emergency Department.

Once you reach the Emergency Department, critically ill or injured patients are seen first, and those with less serious conditions must sometimes wait. In most cases, a triage nurse will assess the severity of a patient’s status upon arrival, based on symptoms, personal and medical history information, and vital signs, such as body temperature, heart rate, and blood pressure.  Emergency department staff work as quickly as possible to have everyone seen, but less critical patients may experience a wait.

Many hospital emergency departments are improving customer service by decreasing waiting times using such measures as registering people at bedsides, streamlining systems that speed specimens to the laboratory, computerizing tracking systems, and developing alternative systems for improving patient flow and processing laboratory tests. Some hospitals are establishing fast-track systems to expedite diagnosis and treatment for patients with less critical conditions. You may be seen by an emergency physician, or if you have a less serious illness, you may be seen by a nurse practitioner or physician assistant who works closely with the physician.  Many hospitals are hiring patient advocates to improve communication, increase the flow of information and better address any concerns of patients.

Since emergency patients are seen based on severity, rather than waiting time, theAmericanCollegeof Emergency Physicians (ACEP) offers the following tips to patients when they come to an emergency department in order to get the best possible care as quickly as possible:

Bring a list of medications and allergies:  What’s the name of the medication you are taking?  How often do you take it and for how long?  A list of allergies is important, especially if there are many of them.  Be sure to include medications, foods, insects or any other product that may cause an allergic reaction.  Bring a medical history form with you.  ACEP has medical history forms available on its web site.  Also consider preparing a consent for treatment form, also available on the ACEP web site, if you are out of town or unavailable to accompany your child to the Emergency Department.

Know your immunizations:  This will likely be a long list for children; mainly tetanus, flu and Hepatitis B for adults.

Remain calm: Obviously it is difficult to remain composed if you’ve been badly injured, but a calm attitude can help increase communication with the doctors and nurses who are caring for you.

The most important factor in dealing with an emergency is to be prepared. This means talking with your physician or your child’s pediatrician about emergency care, developing an emergency plan, and being familiar with the local emergency departments.

For more information, see the AmericanCollegeof Emergency Physician’s web site at: www.acep.org.

Robert Couch, MD, is an emergency room physician at St. Mary & Elizabeth hospital. 

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