5 ways to treat yourself and avoid a trip to the ER

Source: Web exclusive: November 2010

"If you want something done right, do it yourself," the saying goes. And these days, as the Internet brings the world to your fingertips, there are more and more things people want to do themselves. Banking, making travel plans and home renovations are just three of the many things people are doing on their own. So it’s not surprising that more and more patients are wondering whether a little DIY medicine might save them a trip to the ER.

When it comes to self-reliance, there’s another saying worth remembering: "Doctors who treat themselves have fools for patients." If you’ve been shot, I wouldn’t try removing the bullet yourself. And if a bystander collapses on the street, don’t go looking for booster cables to restart the heart.

That said, it’s surprising how much do-it-yourself medicine you can pick up that’s safe to try at home and just may save you a trip to the ER.  Here are five tips worth picking up.

1. Got allergies?

Carry an EpiPen. An anaphylactic reaction is a severe, immediate allergic reaction. Some of the most common triggers include foods, latex, insect stings and medications. The symptoms include hives; swollen lips, tongue and uvula; and difficulty breathing. If you suffer from anaphylaxis, the most effective way to treat the reaction is with an injection of epinephrine.

People can die of anaphylactic reactions, and fatalities are associated with delays in receiving treatment. That’s why pharmaceutical companies developed epinephrine treatments that are designed to be injected by the patient or a family member or bystander. These self-administered auto injectors are designed to be easy to use. They have a syringe of epinephrine plus a needle that penetrates the skin and a spring-loaded mechanism that auto-injects the medicine at the touch of a button.

In most patients, epinephrine is effective after one injection. However, the symptoms may recur and further treatments may be needed to control the reaction. A second dose of epinephrine can be auto-injected after five to 15 minutes. You should still call 911 to be taken to the nearest hospital, even if you’re feeling better. However, this is one form of DIY medicine that could save your life.

2. Strep throat or a virus?

Learn how the pros decide. Streptococcal pharyngitis (known to most patients and physicians as strep throat) is a bacterial infection of the throat. The common symptoms of a strep throat include fever, very sore throat (a throat that feels like you’re swallowing cut glass is an apt description) and swollen, tender glands in the neck. Strep throat is treated with antibiotics to speed recovery and to prevent complications such as rheumatic fever and kidney disease.

Many patients come to the ER with a sore throat because they assume they have strep throat and therefore need antibiotics. In fact, the majority of people who come to the ER with a sore throat have viral pharyngitis, a cold, or a viral upper respiratory infection. Viruses get better on their own and do not require antibiotics. Therefore, the only reason to come to the ER is if you actually have strep throat and need antibiotics.

Doctors use a decision tool called the Centor score to decide whether the patient has a strep throat or a virus. The Centor score has five items or criteria; you get one point for each item that is positive. Here are the Centor criteria:

‘ The first is cough. If you have don’t have a cough, score 1 point; if you have a cough, score 0. 
‘ If you have swollen and tender glands on the sides of your neck, score one point; if you don’t have them, score 0.
‘ The third item is your temperature. If it’s greater than 38° C or 100° F, score 1 point; anything less and you score 0. 
‘ For the fourth criterion, stand in front of a mirror with your mouth wide open and shine a light toward the back of your throat. If it looks swollen or if you see a whitish discharge called pus, score 1 point; if you see neither, score 0.
‘ Finally, score 1 point if the age of the patient is less than 15 years old; take away 1 point from the total score if the patient’s age is greater than 44 years old.

A score of 4 or 5 means you have a 52 percent probability of strep throat and should receive antibiotics. Scores of 2 or 3 mean the probability of having strep throat ranges from 11 to 35 percent; experts say you should have a throat culture and should receive antibiotics only if the culture is positive for strep. If you score 1 or 0, it means your chance of having strep throat is less than 10 percent and you don’t need antibiotics or a throat culture. In other words, if you have a score of 1 or 0, you don’t need to go to the ER.

3. Got frequent urinary tract infections? Plan ahead

Get your doctor to prescribe a "just in case" supply of medication. Most of the time, I don’t recommend self-treatment with antibiotics because the decision to treat should be based on clinical criteria and the risk of antibiotic resistance is too great. But I make an exception when it comes to recurrent bladder infections in women. One study found that rates of antibiotic resistance were no higher in women who were given a prescription for antibiotics to use in case they developed symptoms of a bladder infection  For that reason, I think it’s a good idea for women who get frequent bladder infections to ask their doctor for a prescription to use at their own discretion.

4. Toothache

I see many patients who come to the ER with dental pain. Unfortunately, many emergency rooms cannot provide definitive care because they don’t have a dentist on staff. ER departments that don’t have a dentist can prescribe pain relievers and antibiotics and can administer local anesthetic to provide temporary relief by numbing the affected tooth.

There are things you can do at home to buy time until you can see a dentist and avoid a trip to the ER. The best pain relievers for dental pain are anti-inflammatory medications like ibuprofen. Acetaminophen may be effective as well, but I’d recommend trying ibuprofen first. Anti-inflammatory painkillers provide up to 4 to 6 hours of relief. Oral anesthetic gels that can be applied inside the mouth near the painful tooth may also provide temporary relief. If the pain isn’t relieved by these remedies, you should see your dentist or come to the ER. As well, seek immediate dental or medical attention if your gums or the side of your face are swollen, if you see pus inside your mouth near the painful tooth or if you have a fever.

5. Does a cut need stitches? You be the judge

I see many patients in the ER who assume that all cuts require stitches to heal properly. In fact, many cuts do not need anything more than a good cleaning, some disinfectant, and a bandage. The main reasons why doctors put in stitches are to quicken wound healing and to minimize scarring for a better cosmetic result.

The first thing you need to do is stop the bleeding by applying some pressure and washing the cut with antibacterial soap to gently clear away the debris to get a better look. In general, you need stitches if the cut is on the face or near a joint, or if you have a cut elsewhere in the body that is deep and more than approximately 2.5 cm in length. If the cut is in the shape of a flap, it too generally needs to be sutured. There is one more thing to remember. Only fresh cuts that are no more than 10 to 12 hours old should be stitched; after that period of time, the risk that the cut will become infected goes up quite a bit.

Dr. Brian Goldman is both an emergency room physician at Mount Sinai Hospital and author of The Night Shift (HarperCollins Canada).

Disclaimer: The above information is for entertainment purposes. Speak to your doctor if you want further advice on any of the conditions discussed.