Should you go to the ER?

Source: Web exclusive, September 2010

It’s Monday morning and you’re rushing to start your day. Suddenly, a busy moment turns frantic by the sound of your four-year-old son crying’a plaintive sound that tells you instantly he’s coming down with something that needs medical attention.

You have a maze of options: family doctor, urgent care centre or walk-in clinic, or the ER. But where should you go to get the best and most timely advice? The right answer depends on a number of factors’everything from whether or not your family doctor double-books appointments to how serious little Johnny’s symptoms are. Here is some medical wisdom that can help you decide if you should go to the ER.

When to go to the ER

When experiencing emergency symptoms
Pain, tightness or discomfort in the chest tops the list because these symptoms could mean a serious condition like a heart attack, pulmonary embolus (blood clot in the lungs) or a life-threatening condition called an aortic dissection.  Shortness of breath could be a symptom of asthma, chronic obstructive lung disease, heart failure or pneumonia. Symptoms that could point to a stroke include headache, trouble speaking, difficulty walking or dizziness.  Abdominal pain’often accompanied by nausea and vomiting’could mean you need surgery to remove an inflamed appendix. Internal bleeding or fainting are two more symptoms that mean a trip to the ER is necessary.

When you suspect broken bones
Family doctors may have X-ray facilities in the medical building in which they practice, but are unlikely to have them available at all times. Most urban and many rural emergency departments have access to X-rays 24/7. As well, most emergency rooms have a wide assortment of equipment and facilities to deal with fractures. They have a full range of casting and splinting equipment, as well as crutches and canes, to treat and support most types of fractures. Plus, they have medications and monitoring equipment needed to sedate or relax you should your broken bones need to be set.

Broken hips, knees, and forearms require a trip to the ER since they often require setting, a cast or even an operation. While a cracked pelvis may not require anything other than medications to control the pain, it’s usually safest to have any suspected fracture looked at in the ER.

For treating serious wounds

It’s not always easy to tell whether a cut needs to be closed by a professional using stitches or some other repair technique. Here are some guidelines:

‘ If a wound is deep enough to see yellowish fatty tissue, it’s deep enough to require stitches.
‘ If the edges of the wound are gaping and can’t easily be put together with some gentle pressure, then chances are the wound will need stitches to hold it together long enough to heal.
‘ Wounds in areas that stretch (for example, the calf) are more likely to need repair than those that are on parts of the body that don’t stretch quite so much (such as the forearm).

Always go to the ER if you have diabetes, if the wound is dirty and can’t easily be cleaned, if you experience numbness or tingling on the limb where the cut is located, if you can’t control bleeding from the cut, or if the cut or wound is the result of an animal or human bite.

When to visit the walk-in clinic

Walk-in clinics’also known as urgent care centers and after-hours clinics’offer the benefits of family medicine but with two advantages: They offer a much wider choice of hours than your family doctor and most important, you don’t need an appointment to be seen by a physician. Walk-in clinics are great for minor, one-off problems that should be seen and treated quickly, yet aren’t true emergencies. The list includes things like colds and flus, food poisoning, and minor cuts, scrapes and sprains. If your child (not an infant) has a fever and a runny nose, a cough, a sore throat or a sore ear, then a walk-in clinic is a great place to meet your needs.

Choosing a walk-in clinic instead of an ER means you’ll probably save yourself some serious waiting time. However, one drawback of these clinics is that the doctor you see probably isn’t familiar with your past medical history. So before you go to a walk-in clinic, make sure to know your drug allergies and medical history, and bring a list of your medications along with you.

When to visit your family doctor

With all this talk about ERs and walk-in clinics, you may get the idea that your family physician is sitting in the office with no one to see and nothing to do. But that’s far from the truth’your family doctor is the linchpin of your overall health and wellness. General practitioners (GPs) monitor and manage chronic conditions like high blood pressure, diabetes, heart disease and osteoporosis. They screen you for cancer and are your source of information and advice on prevention and how to deal with family crises. They are experts in managing anxiety and depression. And they can also put out the same acute fires ‘ like throat and ear infections’that their colleagues do in walk-in clinics.

The key to deciding whether or not to see your family doctor is how long you have to wait for an appointment. As I see it, there’s no point waiting five days for a sore throat or a bladder infection. Efficient GPs make time in their office every day to treat patients with acute emergencies. If you choose to see your family doctor, carefully describe your issue to the receptionist or nurse when you call to make your appointment. These front-line pros can let you know whether the doctor can see you that day or not.

Always speak to your doctor for personal medical advice.

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

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