The Transition Network

New York City Chapter

How Do You Know When to Go to the Emergency Room?

(Posted August 25, 2021)

By Jean R. Burg, M.D. 

Knowing when and where to seek medical care when something is wrong can be confusing.  Should I go to the Emergency Room, Urgent Care, call my primary care provider or wait it out at home?  

Here are some tips that will hopefully help you make sensible and safe decisions.

Go to the Emergency Room (ER) or call 911 if you or someone you love has the following symptoms:

• Shortness of breath that comes on suddenly and is accompanied by chest pain, nausea, vomiting, confusion, fainting, or pain in your lower leg.  If you recently had surgery or you were immobilized for any length of time and suddenly have shortness of breath or chest pain, you should go to the ER to be evaluated for a possible pulmonary embolism. If a feeling of shortness of breath makes it so you can’t walk across the room or get out a full sentence without having to stop and catch your breath, you should call 911.

Chest pain, especially on the left side or center of your chest, could be a heart attack.  It’s important to recognize the warning signs and act quickly by calling 911.  Getting treatment early is critical for survival.  Symptoms of a heart attack can vary from mild to severe.  If you have any of the following symptoms, you should call 911 immediately: an uncomfortable pressure or squeezing sensation in the center or left side of your chest (it can last for several minutes, or come and go), shortness of breath, dizziness or lightheadedness, nausea or vomiting, sweating, pain in one or both arms, jaw, neck, upper back or abdomen. Chest pain is the most common symptom of a heart attack, but women are somewhat more likely than men to have other symptoms mentioned above such as shortness of breath, nausea or vomiting and back or jaw pain.

Stroke symptoms: slurred speech, sudden numbness/weakness in any area of your body, facial droop, loss of balance or vision.  A stroke can be caused by bleeding in the brain or a blood clot in the brain.  If a stroke happens, remembering the acronym “act FAST” may save your life. 
  • F (face drooping – when you smile, does one side droop?)
  • A (arm weakness – when you try to raise both arms, does one arm drift downward?)
  • S (speech difficulty - when asked to repeat a simple sentence, are the words slurred or do others have difficulty understanding your speech?)
  • T (time to call 911 immediately – time matters!)
If any of these symptoms are present – CALL 911 immediately.  It’s important to get to the ER right away because time matters.  The sooner treatment is started, the better your chances of recovery.

Other symptoms of a stroke could be:  
  • Sudden loss of balance, lack of coordination, dizziness
  • Sudden difficulty seeing in one or both eyes
  • Sudden severe headache with no known cause
  • Confusion

Headache that comes on suddenly and seems to be the worst headache of your life could be a subarachnoid hemorrhage caused by a ruptured brain aneurysm.  A brain aneurysm is a bulge or ballooning of a blood vessel in your brain.  Most do not rupture or cause health problems, but if it does leak or rupture, this can be life-threatening.  The headache is often accompanied by nausea and vomiting, a stiff neck, blurred or double vision, confusion, loss of consciousness or a seizure.  If you have a sudden, severe headache that feels like the worst headache of your life, call 911 immediately.

•  Serious burns and cuts -  A burn is serious if it is larger than the palm of your hand or you notice white or charred skin.  If the burn is on your face, hands, feet or joints, it’s best to go to the ER.  For cuts, go to the ER if: the wound won’t stop bleeding after you apply pressure for 10 minutes; the wound is on your face; blood is spurting out; the wound is deep or the edges are jagged; the wound is a result of an animal or human bite.

Seizure that lasts for more than a few minutes, you remain unconscious after the seizure ends, or this is your first seizure (no matter how long it lasts)

Nausea and/or vomiting accompanied by severe abdominal pain or severe cramping, weakness, chest pain, confusion, high fever, bloody or black tarry stool  

Diarrhea that is accompanied by any of the following: fever >102, severe abdominal pain, bloody or black tarry stool, frequent vomiting, more than 6 bouts of diarrhea in 24 hours

Dehydration (severe) happens when you lose fluids and are unable to replace them through drinking.  The loss of fluids can occur from vomiting, diarrhea, excessive sweating, high fever.  Go to the ER if you have the following signs of severe dehydration: dizziness, rapid heartbeat, weakness, no urination or small amount of urine and the urine is very dark yellow.

Severe allergic reaction causing swelling of your lips, difficulty swallowing or difficulty breathing

A sudden change in mental status such as confusion, being disoriented, suddenly not able to think or remember clearly.

Loss of consciousness (if you pass out).

Multiple injuries or a possible broken bone in areas like the ribs, skull, face or pelvis Sometimes the problem may not be severe enough to warrant a trip to the ER and could be evaluated and treated at an Urgent Care center.  Many urgent care centers are open 7 days a week with extended hours into the evening. They may have a shorter wait time than the ER.  Always check their schedule to be sure they are open before going to the urgent care center.  

Many urgent care centers can do X-rays and blood tests to assess your illness or injury. 

Always remember, if the urgent care provider thinks you need a higher level of care, they will get you to the ER.

Go to an Urgent Care center if you have the following symptoms:

Fever over 102 that doesn’t come down with OTC fever meds such as acetaminophen or ibuprofen. 

Vomiting and nausea that persists for several hours and you can’t keep anything down, but not fitting the description above that would send you to the ER.

Diarrhea  4-6 times a day for more than 2 days and doesn’t fit the description above that would send you to the ER.

Dehydration (mild to moderate)– dry mouth, less urination than normal and dark yellow urine, headache, muscle cramps.

Strains or simple bone breaks: when the body part isn’t "pointed" in the wrong direction or — in the case of suspected broken ankles or knees — you can still walk on the injured leg even though you have some discomfort.

Minor cuts: bleeding stops after applying pressure but the wound is deep enough or wide enough where it does not look like it will close on its own without leaving a large scar.

Mild asthma attacks that don’t improve when you use your regular asthma medicines.  If you are still able to walk across a room and speak in a full sentence without having to stop to catch your breath, you can go to urgent care. If walking or talking are too difficult due to shortness of breath, go to the ER.

Pain with urination, the sensation of needing to urinate urgently, fever.

When to call your primary care provider:

**Symptoms suggestive of the flu or many other viruses: temperature below 102 degrees or above 102 that comes down with use of acetaminophen or ibuprofen, body aches and pains, a mild cough, sore throat, headache.  Start by “doing what your mother used to tell you” – rest, drink plenty of fluids, take an over-the-counter medication like acetaminophen, if needed, and monitor your symptoms.

**Mild nausea and vomiting but you are urinating normally.
If your symptoms aren’t getting any better over time (a few days) or if they worsen, and you feel you need to be seen by a doctor, call your primary care provider.  Many primary care providers are now offering virtual visits and can see you by a video visit or phone call.
For more information, see full article HERE

Material from, 01:44:53 December 3, 2021.
Copyright © The Transition Network 2021