Wednesday, April 6, 2011

The Letter E is for Emergency

E is for Emergency. How do you decide what needs a visit to the emergency room, what can wait for the doctor's office, and what can just wait and see?
Follow these tips to make a quick decision:

  • Bleeding- active bleeding that cannot be controlled, bleeding from the rectum, or vomiting blood needs to be evaluated in the emergency room. Sutures will close lacerations and wounds, and bleeding from the stomach or intestines requires immediate evaluation and intervention by a qualified physician.
  • Breathing- compromised breathing, noisy breathing, breathing that sounds like an obstruction, and any breathing difficulty that causes a change in color or mental status needs evaluation. Children with severe asthma often need to be seen on an emergent basis for an acute onset of asthma. Croup, epiglotitis, and whooping cough all can be causes of noisy breathing that should be evaluated by a physician if you are in any doubt.
  • Level of consciousness- any change in the level of consciousness of a child should be evaluated. I am not talking about a sleepy child who talks silly when he first wakes up. I am talking about a lethargic, slow to respond child who may have sustained an injury or illness which is altering his level of normally alert behavior. Any undiagnosed seizure should also be evaluated by a physician.
  • Fevers over 104 F- that do not respond to Tylenol or Ibuprophen within 30-60 minutes should be evaluated by a physician. This can be a gray area. If you are lucky enough to have a pediatrician who takes calls, fevers can be handled over the phone by discussing treatments with your doctor. In most cases, fevers that run over 104 F and do not come down should be seen in the emergency room.
  • Broken bones- any time you suspect an injury may have caused a break in a bone the emergency room is the most likely place to go. The exception would be if there is a single injury to a wrist or ankle and your doctor is in the office, that may be the quickest and most appropriate place to take your child. In general, broken bones result from a trauma of some sort and it may be related to more than one injury. The emergency room is prepared to evaluate this type of thing, intervene, and refer you to a specialist if needed.
  • Burns, near drownings, multiple injuries- Seek treatment in the nearest emergency room if there are significant burns with blisters, a near drowning incident, or multiple injuries that make it difficult to evaluate.
Keep in mind this: Airway, breathing, circulation, level of consciousness-When you have a serious compromise or alteration with any of the four issues listed, it should be an emergency room visit.

Anytime you have an auto accident, have a cardiac event or chest pain that may cause a cardiac arrest, or think someone maybe having stroke symptoms, don't hesitate to call 911 for immediate assistance.

When you are home and have a choice to make about what kind of care to seek, use the above tips to help you decide.

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