It's your little leaguer's first time at bat. The pitcher releases the ball, and... thwack! Your star batter is on the ground, conscious, but crying. Seasoned parents tell you five minutes on the bench and he'll be fine. You, though, feel torn between an ice pack and an X-ray. Is it worth the long wait in the emergency room? How can you tell? What is an emergency these days?

"If you feel uncomfortable, bring them in. Period." Elda Ramirez, PhD, RN, chooses to trust the gut instinct of the parent. "You know your kid, how they respond, how they behave. Better to be sent home from the ER than to have wished you had made the trip," says Ramirez, an associate professor of clinical nursing for emergency nurse practitioners at The University of Texas School of Nursing at Houston.

After 15 years of emergency room nursing experience at both Memorial Hermann-Texas Medical Center and Lyndon B. Johnson General Hospital, Ramirez broadly defines a condition worthy of a trip to the ER as, "anything over which the patient or caretaker believes they do not have control." And, though most of us think of the standard ABCs of emergency visits—airway, breathing, circulation—"pain is still what brings in most of the patients," Ramirez reminds. And, pain can be anywhere.

Head injuries

So let's start at the top—the little leaguer's run-in with a baseball. Ramirez explains that head injuries are tricky, but there are guidelines. "Any head injury involving laceration [cut skin] is a hard hit and needs to be examined," she says. Any loss of consciousness, even for a blink, unusual sleepiness, uneven eye dilation and vomiting are signs of concussion. But again, Ramirez advises, the behavior of the patient, especially a child, is a better indicator. Concussion can appear symptom-free, "except that your child just isn't 'herself.' And that's the best reason of all to bring her in."

Bone and spine injuries

Spinal injuries, especially the neck, should be assessed by a medical professional. Ramirez chooses to focus "on the mechanism of injury. There's a difference between falling down a flight of steps at age 8, and one step at age 88." Each must be assessed individually. Any numbness, tingling or intractable pain is suspect. Orthopedic injuries, where there is "100 percent deformity, such as legs bent backwards or bones sticking through skin," constitutes not only an ER visit, but a ride by ambulance. Blue or whitish finger or toe tips, as a result of a suspected break, indicate immediate attention as well.

Cardiovascular symptoms

And of course, any cardiac symptoms should send you quickly to your nearest ER. Time is at a premium. "People don't realize how much heart damage we could stop if only they had called an ambulance instead of their neighbor," Ramirez says. Women seem to have more referred symptoms, like back, elbow or shoulder pain, "easy to ignore or write off as their typical daily aches, until it radiates to a new place, like the jaw." Men wait until they feel generally horrible, reporting the typical clamminess, shortness of breath and chest pain. Yet, they deny any knowledge of family history of heart disease, "even when their own fathers, uncles and brothers have already had major attacks." Learn to recognize the signs of heart attack and stroke.

Gut symptoms

Surprisingly, one of life's least threatening events can turn into the most dangerous in the span of a few hours: stomach ailments. Ramirez cautions that kids and seniors must be seen before 24 hours is up if severe vomiting or diarrhea prevents them from holding in fluids. "Dehydration will take a very young life or very old life—very quickly."

Super bugs

Micro-organisms just aren’t what they used to be—they’re meaner and stronger. This doesn’t translate to a trip to the emergency department every time a pimple grows angrier or a boil develops under your child’s football shoulder pads. It does mean that skin eruptions, insect bites or wounds that suddenly grow hot, red and expansive should receive immediate care. If you have a systemic fever, red streaks originating from the wound or if the wound is near a joint space, seek emergency medical attention. “Particularly folks who also are immune-compromised, such as diabetics, certain heart patients or persons with HIV/AIDS,” warns Ramirez. “We need to see you if you have health conditions that could provide a far more favorable environment for infection."

Get sick on a Wednesday

Now that you know when to go to the ER, are there times when a phone call to your doctor would suffice? Healthy adults who have nausea, vomiting and diarrhea but no symptoms of dehydration don't need a visit to the ER, nor do people with simple sore throat or cold symptoms. "If you feel your condition can wait until a regular office appointment, by all means, call your doctor first. They will advise you if you should proceed to the ER," Ramirez suggests. But most primary care physicians are not comfortable assessing an emergency over the phone. Often they will send the patient on to the ER and call ahead with instructions. "Which does not mean you will receive preferential treatment or be seen any earlier. Remember, there may be three heart attacks in front of your broken ankle and they will come first."

The most important thing to remember, says Ramirez is "to trust your instincts. We trust your instincts implicitly."

 

 

 

Last Updated: 3-11-2009

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