by

Charles A. Bertrand, M.D., FACP, DIM-CD (Ret.)
Associate Clinical Professor of Medicine at New York Medical College
and at the Medical University of South Carolina

WHEN TO GO TO THE EMERGENCY ROOM?

Besides reviewing current medical journals I read three medical newsletters each month. One is from Harvard, the second from Johns Hopkins and the third from the Mayo Clinic. All are excellent. There are many others that impart excellent information as well.

This month, the Harvard health letter was concerned the above question -- when to go to the emergency room?. If that question were asked to an internist, he would probably say that the person who had symptoms suggesting a heart attack or stroke should be seen promptly in the emergency room. He might add other conditions, such as internal bleeding as well. The surgeon, with his background, might consider different forms of trauma, such as an auto accident, or a fall with possible fracture of a bone, abdominal pain etc.

The article discusses several symptoms relative to a heart attack- particularly chest pain or pain in the shoulder going down the arm, sometimes even heartburn. It also mentions other cardiac symptoms such as shortness of breath, rapid pulse, palpitations. Palpitations can be very important or sometimes not -- in this situation it is particularly helpful to discuss this matter with one's physician.

Trauma is pretty much self-evident -- if one happened to be involved in auto accident then it may be worthwhile to have a complete evaluation. Unexplained abdominal pain can be quite important and should be checked out. Weakness, fainting, pallor can be signs of bleeding and therefore are important.

There are other such situations - fainting, unexplained sudden headache for example. Once a decision is made to go to the emergency room it should be done quickly, calling 911 or whatever the emergency phone number is for your area.

Why is speed so important? Well, in many situations, the rapidity of treatment is important to affect a more favorable outcome. A key example is a heart attack-- patients who arrive alive in the emergency room have about a 95 percent survival chance if treated within one hour of the onset of symptoms. However,the survival rate drops quickly after 2 or 3 hours.

In addition to going by ambulance it is also important to go to the nearest facility,since the time factor is so important. The flip side of the question is who should not go to the emergency room -- some examples are as follows: you wish a second opinion, you have run out of medicine taken for chronic condition and need a refill, you want to have an injury evaluated because of a pending insurance claim, lawsuit, or on an attorney's advice.

If in doubt, go and go quickly, by ambulance and to the nearest emergency facility!



The advice provided on this website is intended to be general in nature and should not be relied upon for specific treatment. If you need personal medical attention please contact your physician.


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