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When should I go to the Emergency Room?

This month, I’ve had the privilege of working in the emergency department at one of the busiest hospitals in Chicago. I’ve had the chance to treat real emergencies, but have also seen a lot of situations that really weren’t emergencies. What does constitute a medical emergency worthy of an ER trip?

This is a difficult question, even for me. If I’m feeling unwell, I like to receive treatment for my condition quickly, and have immediate answers about my ailments. I was no stranger to both Urgent care and ER as I grew up.

It’s impossible to list all of the reasons why you should, or should not, go to the ER, and legally, no one can tell you whether or not to go in. But, I can share some experiences that will hopefully help delineate emergencies from non-emergencies.

Must go situations:

If you have a life-threatening condition:

Shortness of breath—this isn’t just having a hard time catching your breath after exercising; if you are having a difficult time breathing and getting enough oxygen, go in and get treated, as this may be indicative of a more serious condition.

Chest pain—sharp, stabbing, or burning sensations in the chest, unrelated to food consumption, can be indicative of a serious condition. If you suspect heart problems, get it checked out.

Uncontrolled bleeding—If you can’t get the bleeding to stop, because of the seriousness of the injury, or because you’re on a blood thinner, go in right away!

Lacerations—If your cuts are deep, and require more than a bandaid to hold them closed, go in for stitches or staples. You might have to wait a little longer depending on the seriousness, so consider an urgent care facility.
If you have an open wound or ulceration and develop fever/nausea/vomiting/chills—these are indicative of an infection, and you need immediate treatment.

Broken bones – although not immediately life-threatening, broken bones need immediate treatment, and are definitely a reason to come in.

Suspected miscarriage—if you’re pregnant and begin bleeding, or have any sudden gush of fluid, call your o.b, if you have one, and get to the ER or the hospital where your doctor is on call.

Complications after surgery – Follow your doctor’s instructions which will tell you when you should go to the ER.

Why should you not go to the ER?

This is a tougher one at times, yet, let me explain a few times when you should schedule an appointment with a podiatrist
1) Why today? Why right now?

This is a great question to ask yourself if you have a less serious condition, but decide that you prefer to spend 3 hours in the ER instead of setting an appointment with your primary care physician for a more convenient time.

If you answer this with: my condition is significantly worse or is worsening; the pain has drastically increased or is now unrelenting and constant; you suspect an infection with pus, drainage, inflammation, red streaks spreading away from infection site, accompanied by a fever…then you should go in to the ER, otherwise, make an appointment.

2) Chronic pain—if you’ve had foot pain for months, you can probably wait for an appointment with a podiatrist instead of going to the ER and waiting there, to likely only get a referral to a podiatrist.

3) Acute injury—it hurts, but isn’t broken, and you can manage the pain until you can see a podiatrist.

4) ER doctors are amazing, but they are not specialists. You will not get the specialized care you may need to best treat your condition in the ER. If you have a foot problem, call your podiatrist.

5) Would you take an ambulance? Would you request help for your problem at the scene of an accident, after a tornado devastated the area? These questions can help you assess the severity of your condition.

Here are some real-life examples where it was a good Reason the patient came into the ER:

1) Torn Achilles tendon: patient heard a loud pop playing a sport
2) Large laceration that wouldn’t heal on its own, severe bleeding
3) Infection: redness, swelling, hot, loss of function to the foot. Accompanied by fever, nausea and chills.
Reasons we thought the patient shouldn’t have come in:
4) Heel pain that patient has been dealing with for 1 year
5) Fungal nails thought to be an “ingrown toenail”—a topic for another post (ingrown toenails aren’t emergencies either, and ER doctors aren’t as equipped to take care of an ingrown toenail as your podiatrist is.)
6) Foot fungus/rash

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