Working as an RN in an emergency room, I have seen numerous cases of people coming to the ER for something that they could easily remedy in the privacy of their own home. On the flip side, I have also seen people wait too long to come to the ER with serious symptoms that ultimately lead to a preventable death. So what is a person to do?? How do you know if you should visit an ER or stay at home and tough it out?
Well, as always, I caution that the following are guidelines based on my experience and you should ALWAYS CONSULT YOUR DOCTOR IF YOU ARE FEELING ILL.
First of all, the purpose of an emergency room is to treat or rule-out ONLY life threatening conditions. If you have had a swollen lymph node for months, for example, and you are beginning to have other symptoms that you fear could be some kind of cancer, the ER is NOT the place to go. Even if you DO have cancer, the ER is not reimbursed by insurance to do the necessary tests to diagnose you. The ER will do basic testing to make sure you do not have a condition that will kill you immediately, but beyond this they will merely tell you to follow-up with your primary care doctor who can do further testing.
The ER only functions if it moves people in and out quickly (whether it be to send you home for further testing or to the ICU for more invasive care) so that rooms are available for newly arriving ambulances and walk-in patients. Also important to note: expect a wait when you visit an ER! Triage, or treatment order based on severity of symptoms, is the nature of care provided in an ER. Even if you arrive to an empty ER with a complaint of abdominal pain and expect quick service, if another patient arrives, say, with a severe head injury, regardless of who arrived first the patient who needs immediate care the most (the head injury patient) will skip to the front of the line, leaving you waiting in your tiny ER room while everyone's focus is on taking care of the other more critical patient. It is frustrating (I have seen people wait 6 hours or more on busy days), but it is part of the unpredictable nature of an ER. If you are stable, meaning you are breathing and your heart is beating without difficulty, you are almost always guaranteed an extended wait at the ER.
So understanding how an ER functions gives you a slightly better idea of what to expect, but how do you know if you need to visit one? Here are some simple guidelines:
WHEN TO GO TO THE ER:
*SUDDEN onset of SEVERE symptoms, ie:
-Crushing chest pain or pressure (if you have a history of anxiety attacks but NO history of ANY KIND of vascular or heart related problems, wait until you have tried calming techniques and any medications you may have at home before going to an ER), with or without pain/tingling in your left arm
-If you have an extensive medical history (particularly a cardiac history like high blood pressure,high cholesterol, previous heart attacks or strokes) and begin excessively sweating, vomiting, feeling severely fatigued, or having uncontrollable nausea WITHOUT presence of a fever (these can all be signs of a heart attack, even without the chest pressure)
-Sudden difficulty speaking, slurring words, numbness or tingling on one side of the body, drooping of one side of the face, weakness on one side of the body (again, if you have a history of high blood pressure or ANY cardiac issues and experience these symptoms, you need to immediately get to an ER! These are symptoms of a stroke)
-Fever above 102 degrees for more than 6 hours (IN CHILDREN, ANY FEVER WARRANTS A CALL TO YOUR PEDIATRICIAN who can direct you to an ER if necessary. Any other fevers in adults: call you primary care doctor before visiting an ER)
-SUDDEN, UNEXPLAINABLE, and INTENSE abdominal pain or flank pain that does not resolve within an hour
*Any kind of trauma, ie:
-Lacerations that may need stitches
-Broken bones or suspected broken bones
-Car accidents
-Head injuries
-Etc.
WHEN TO STAY AT HOME:
*Flu-like symptoms in an otherwise healthy person
-The flu and the common cold are caused by VIRUSES. Viruses cannot be treated with antibiotics, in fact they cannot be treated at all. The goal of treatment when dealing with a virus in treatment of SYMPTOMS, so taking acetaminophen for fever (if above 102 degrees. Otherwise, fevers are actually beneficial in helping you body kill the virus. Again, in children always consult an MD), drinking LOTS of electrolyte infused fluids (like coconut water and gatorade. Aim for unsweetened like coconut water, and you'll need close to 3 liters a day of fluids if you have a fever or are losing fluids through vomiting or diarrhea), and resting. The biggest risk with the flu is DEHYDRATION, so make sure to drink lots of fluids! And if you are having diarrhea or vomiting, make sure those fluids have electrolytes in them, since you lose potassium when vomiting and put yourself at risk of life threatening hypokalemia.
ALSO NOTE: Watch for signs and symptoms of pneumonia when recovering from flu, since pneumonia is definitely a reason to visit an ER! Symptoms include shortness of breath, productive cough, difficulty catching your breath, and confusion.
*Chronic pain
-Contact you primary care doctor or visit a pain clinic. You are guaranteed only a referral and a LONG wait if you go to an ER with chronic pain symptoms
*Drug seeking
-Upwards of 75% of patients I see in the ER are attempting to obtain narcotics. If you are an addict, please speak with your primary care doctor about treatment options. Taking the MD and RN's time in an ER only puts other patients who need their care at risk.
If you have symptoms that are abnormal and that you cannot explain, call you primary care doctor to set up an urgent appointment. If you do not have a primary care doctor, look for an Urgent Care center, free clinic, or set up an initial appointment to be seen by a new doctor BEFORE heading to the ER. This is the best way to stay healthy, manage your own health care, and keep the ER open an available to you in case you have a health emergency in the future. Good luck and good health!!
