When do you need to go to the Emergency Room?

Emergency rooms are open 24/7/365. They are staffed with providers such as Emergency Medicine Physicians, NPs ( Nurse Practitioners), and or PAs (Physician Assistants) who all provide high-quality care regardless of the ability to pay. Upon arriving at the ER, patients are medically assessed through a medical screening examination.

Following that initial evaluation, the medical professional maps out a course of treatment. These actions may include drawing blood, taking X-rays, and computerized axial tomography(C.A.T.) scans. This testing may occur before or after being admitted to the ER, depending on how busy that day might be. If you have life-threatening concerns, expect rapid treatment; if not, sometimes it is better to wait to go to the ER!

The National Hospital Ambulatory Care Survey 2020 data shows 131.3 million emergency room visits and 18.6 million hospital inpatient admissions. Only 14.2 % of these visits resulted in hospital admissions.

Medical emergencies are frightening, and with time being of the essence, it is essential to recognize what is a true emergency. The Emergency Physicians Organization is a great resource and has a list of adult emergency symptoms:

Am I Having a Heart Attack?

• Heart attack symptoms may include difficulty breathing, shortness of breath, and chest or upper abdominal pressure lasting over 5 minutes.

• These symptoms, or a combination thereof, may indicate a cardiovascular emergency.

My blood pressure is high!

• Elevated blood pressure alone rarely requires hospitalization.

• A high blood pressure reading of 180/120 with chest pain, shortness of breath, numbness, weakness, changes in vision, or difficulty speaking may be a symptom of a hypertensive crisis.

• If you do not have additional symptoms, your medication may need to be adjusted. In this case, your primary care provider (PCP) can help.

Am I having a stroke?

Vision changes; difficulty speaking; confusion or changes in mental status; sudden numbness in the face, arm, or leg, especially on one side of the body; and difficulty waking are symptoms that may indicate a stroke or Transient Ischemic Attack (TIA). Do the following for yourself or someone you believe may be having a stroke.

Act F.A.S.T. to identify stroke and do the following test:

• F (Face)- Smile. Does one side of the face droop?

• A (Arms) -Can you raise both arms or does one arm drift downward?

• S (Speech) - Can you speak a simple phrase without slurring? Can you repeat “no ifs ands or buts?”

• T (Time)- If you see any of these symptoms, call 911.

• If the symptoms disappear, you may be experiencing a TIA and need emergency help.

My stomach hurts!

Abdominal or pelvic pain, severe or persistent vomiting, or diarrhea- may indicate appendicitis, gallbladder disease, kidney stones, infections, or inflammation.

While not all abdominal pain is a cause for a visit to the ER, there are some reasons to go for an evaluation.

• Pain in the right lower abdomen associated with fever, decreased appetite, nausea, vomiting, and/or diarrhea could indicate appendicitis.

• Pain in the right upper abdomen with nausea or increased pain after eating could indicate gallbladder issues.

• Pain in the flank (sides where your arms rest while hanging) could indicate kidney stones or infections.

• Blood in your stool always requires an evaluation in the ER, especially if you are taking blood thinners.

For female patients, abdominal pain may indicate ectopic pregnancy, pelvic inflammatory disease, or ovarian cysts. If you are pregnant and experience vaginal bleeding, this may indicate a potential miscarriage and requires medical attention. Some hospitals have obstetrician-specific emergency departments, but all emergency rooms can see and manage this medical condition.

What to do if someone is choking and becomes non-responsive?

For an unconscious choking adult,-apply the A.B.C. assessment immediately.

• A-Is the AIRWAY open?

• B-Are they BREATHING?

• C-CIRCULATION-do they have a pulse?

• If the answer is no for A, B, or C, call 911 for immediate aid.

I had a traumatic injury!

Traumatic Injury can occur from but is not limited to, a fall or motor vehicle accident that results in a head or spine injury, burn or smoke inhalation, near drowning, or deep or more extensive wound.

In serious yet rare occasions following a head injury, you may have developed a hematoma, a blood collection in the brain.

The following signs and symptoms are considered red flags:

• One pupil is larger than the other

• Drowsiness, loss of consciousness, inability to awaken

• A headache that gets worse or does not go away

• Slurred speech

• Confusion

• Loss of consciousness

• Repeated nausea and vomiting

• Seizure activity

My temperature is high!

• Fever in adults of equal or greater than 103 degrees with additional symptoms such as abdominal pain, nausea or vomiting, severe headache, stiff neck, rash, change in behavior, or cough with shortness of breath requires immediate medical attention.

I took too many pills!

• If you ingested too many pills, prescription or over-the-counter, contact the poison control center immediately at 1-800-222-1222. They can instruct you on what to do and when to go to the Emergency Room.

I am thinking of hurting myself or others!

• Suicidal or homicidal feelings are reasons to be seen in an Emergency Room. Contact the 988 Suicide and Crisis Lifeline to connect with a trained counselor for yourself or someone in crisis.

A medical emergency is something we may all encounter during our lifetime. Know when to seek help. Emergency rooms are overcrowded, and wait times can be lengthy. ER providers are exhausted by non-life-threatening complaints. Recognizing symptoms that require emergency treatment can save lives. Stay proactive and up to date on your immunizations and screening. If or when you need to go to the Emergency Room, bring an updated medication list, know the names of your providers, and be ready to answer lots of questions!

Steven Katz MD and Cindy Katz D.N.P.

Dr. Steven Katz is a board-certified Emergency Medicine physician who has practiced for ten years. He currently works in Nashville, Tennessee, and serves as the Medical Director of his Emergency Room.