chest pain 2 webIn recent years we’ve heard about the importance of not going to an emergency room unnecessarily. Although sometimes it’s obvious that you need emergency care, other times it may be less clear. When deciding whether to visit your nearest emergency room, Rebecca Pequeno, MD, Chair, Emergency Medicine, St. Luke’s University Health Network, suggests you first ask yourself how quickly does the person in distress need help? If someone’s life is at risk or they could be permanently disabled, don’t hesitate, call 911 immediately. Examples are chest pain, difficulty breathing, stroke symptoms, heavy bleeding, and a fall where the person can’t get up or is unconscious.


“If you’re on the fence regarding whether to drive yourself, or call an ambulance, it’s best to err on the side of calling 911,” she says. “By calling an ambulance, you get trained personnel with access to equipment and medication so life-saving care can occur on the way to the hospital."

The ambulance personnel are in constant communication with emergency room physicians who guide them. They can relay information on vital signs, exam findings and treatment that has been started in the ambulance so the ER can prepare for the patient’s arrival.

“By having that information, we can be ready when you come through the door,” Dr. Pequeno says. “For example, if you’re having a heart attack, we can prepare the cath lab (cardiac catheterization laboratory) to unblock your arteries. If you’re having a stroke, we can align the stroke team and get you directly to the CAT scan machine. With stroke, time is brain, every second matters.”

Although every situation is different, the following could be symptoms of a life-threatening condition such as heart attack, heart failure, stroke, bleeding in the brain or stomach. Seek immediate emergency care in the following situations:

  • Shortness of breath, trouble breathing or heavy breathing
  • Severe chest pain or pressure
  • Sudden severe headache
  • Sudden severe stomach pain
  • Weakness/numbness on one side, drooping of the face, slurred speech or sudden confusion or inability to speak, see, walk or move
  • Choking
  • A head injury with passing out, fainting, or confusion
  • A neck or spine injury, particularly if there is loss of feeling or inability to move
  • Electrical shock or a lightning strike
  • Severe burns
  • Inhaled smoke or poisonous fumes
  • Seizures
  • Possible broken bone, loss of movement, particularly if the bone is pushing through the skin
  • Serious eye injuries
  • Suicide attempts or thoughts

Other situations that may require immediate care or indicate a serious health condition include: 

  • Pain in the arm or jaw
  • Dizziness or weakness that does not go away
  • Heavy vaginal bleeding, especially if pregnant
  • Deep wound
  • Serious burn
  • Coughing or throwing up blood
  • Severe pain anywhere on the body
  • Severe allergic reaction with trouble breathing, swelling or hives
  • High fever with headache and stiff neck
  • High fever that does not get better with medicine
  • Throwing up or loose stools that does not stop
  • Swelling in the legs
  • Sudden vision changes or loss of vision in one or both eyes

For many common conditions, it is best to schedule an appointment with your primary care physician, or if you can’t wait, go to an urgent care center. These include:

  • Colds
  • Flu
  • Earaches
  • Sore throats
  • Migraines
  • Low-grade fevers, and limited rashes
  • Sprains
  • Back pain
  • Minor cuts and burns
  • Minor musculoskeletal injuries
  • Minor eye injuries

When Should You Seek Immediate Care for the Flu?
You’ve probably heard that it’s not necessary to seek help in the emergency department for the flu. While, that is generally true, exceptions exist. “Most people get the flu and feel lousy for a few days before recovering,” says Rebecca Pequeno, MD, Chair, Emergency Medicine, St. Luke’s University Health Network. “Generally, the best treatment is to stay at home, get plenty of rest and fluids and take a fever reducer to bring down fever and reduce achiness. However, some people can develop serious, and even life-threatening, complications. In fact, each year thousands of Americans die from flu-related illnesses.”

Those most susceptible to developing complications are children under age five; adults over 65; pregnant women; and people with chronic heart, lung, kidney or liver disease or diabetes. Other chronic illnesses or risk factors may affect a person’s ability to fight infection and make them more susceptible to the flu and its complications.

The CDC recommends that patients who are at high risk of serious flu illness should take flu antiviral medications soon after developing symptoms of the flu. Patients should contact their primary care doctor if they develop symptoms of the flu to determine whether they should receive these medications.

Dr. Pequeno cautions that it is important to be vaccinated against the flu every year because even otherwise healthy people can also develop flu complications. In fact, according to the Centers for Disease Control, the 2017-2018 flu season was among the worst on record with 80,000 deaths, including many healthy people.

“If you have trouble breathing seek immediate help,” Dr. Pequeno says. “Pain or pressure in the chest or abdomen, sudden dizziness or passing out, confusion, high fevers that don’t improve with medication or severe vomiting can also signal that you are developing serious complications.”

Patients who develop any of these signs of complications from the flu should be seen in the ER. Fortunately, most patients with the flu do not need to be seen in the ER and can start by contacting their primary care physician to discuss their care, she adds. “Young children, however, may not be able to tell you what they are feeling so pay close attention to how they are acting,” Dr. Pequeno cautions.

“If you are caring for your grandchild or other youngster – especially an infant – and the child is breathing fast or has difficulty breathing; has bluish skin; a fever with a rash; decreased wet diapers, is drinking very little; or is less responsive than usual; don’t hesitate, take the child to the emergency room right away.”

If you have the flu, be on your guard should you start to feel better and then relapse, she advises. Call or see your doctor because it could be a sign that you have a secondary infection such as pneumonia. “Also, get a flu shot,” she says. “It’s still not too late.”

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