Let's say you decide to visit your local ER because last night you developed a low-grade fever and earache. You drive yourself for care and describe your symptoms to the triage nurse, who then has you take a seat in the waiting area. And while you wait, other patients seem to be jumping ahead of you in the queue. Hey, you've been waiting much longer than the woman complaining of chest pain and dizziness, and you've definitely been here longer than the man who cut off his finger; what's that all about?
Wondering whether an illness or injury is a medical emergency? You just need to know your ABCs. Because the body can't survive without oxygen, any complaints relating to airways, breathing and circulation are potentially life-threatening and considered an emergency. Emergency departments don't prioritize patients based on a first-come, first-served model. Instead, patients are seen based on the severity of injury, so the less sick or wounded you are, the longer your wait will be. You could be waiting for hours, and that wait will be longer on the weekends and some nights.
Many visits to emergency departments could be treated by a general care health professional. And that treatment would cost a lot less, too. On average, a visit to your primary care doctor costs around $150. If that sounds expensive, then you won't want the $1,000 — or greater — bill that follows an average visit to the ER. And whether or not your condition is actually an emergency, if you go to the ER for care, the emergency medical team is obligated to at least give you an exam [source: Blue Ridge Healthcare].
So you've got to ask yourself one question: Is the reason you're considering emergency care a life- or limb-threatening situation, or is it just that it seems more convenient to go to the ER (or to call for an ambulance) than to wait a day or two for your doctor to have an available appointment?
Sprains, Strains and Other Minor Trauma
Sprained ankles are super common injuries: As many as 25,000 people sprain their ankles every day [source: American Orthopaedic Foot & Ankle Society]. With all those sprains you'd think we'd be experts at self-treating a minor trauma, but most of us don't know what to do when it happens — so we go to the emergency room. Most sprains and strains can be treated right at home with the proper first aid: rest, ice, compression and elevation (RICE) during the first two days. And yet, it's estimated in 2009, more than one-third (36 percent) of all ER visits in the U.S. were for sprains and strains to lower extremities. That includes hips, knees, ankles, thighs, legs and feet, but a twisted ankle is most common [source: Lambers et al.].
Sprains cause bruising, swelling and pain; an awkward twist or fall is all that's needed to stretch or tear ligaments (those are fibrous bands of collagen connecting bones to other bones to form a joint). A strain is a little different. Strains happen when you overstretch or tear a muscle or tendon (the tissue that connects your muscle to your bones), such as straining your back trying to lift a heavy object. Sprains and strains are typically minor injuries, albeit painful.
If you think your injury is more severe than a torn ligament or overworked muscle, visit your primary care physician or medical team at an urgent care center for an X-ray to evaluate the damage. Breaks, fractures and dislocations often need additional treatment beyond RICE. Save the visit to the emergency department for severe injuries such as visible bone. Otherwise, you're going to spend a lot of time in the waiting area while emergency teams focus on patients with life-threatening conditions.
Third- and fourth-degree burns (yes, there are burns worse than third-degree) are life-threatening medical emergencies because of the extensive damage not only to the layers of skin but to tissue, muscle, tendons, ligaments, blood vessels, bones and nerves. Burns on the face, feet, hands, genitals, backside or on a joint are also best treated as emergencies rather than with at-home first aid or a wait-and-see attitude. Otherwise, the burn probably doesn't need emergency attention. Try urgent care or call your doctor.
Burns are evaluated based on cause, including contact burns, fire, scalding, chemical, electrical and radiation. The size and depth of the burn, location of the injury and the burn victim's age are also considered. First-degree burns, such as sunburns, cause skin to turn red, and there's usually both swelling and pain; these burns are considered minor burns, because the burn affects only the outer layer of the skin. Then there are two classifications of second-degree burns, based on how deeply the skin is damaged. Scald burns, the most common burn among kids and adults, are typically superficial partial-thickness burns, while something like splattering hot grease is more likely to cause a deep partial-thickness burn [source: Edlich et al.]. Second-degree burns that are less than 3 inches (7.6 centimeters) in diameter are considered minor burns.
Minor burns can be treated at home, beginning with a cool water bath of the burned area. Apply aloe vera or an antibiotic cream to the wound and dress it with dry bandage. With care, first degree burns will heal in a week or less, and second-degree burns in two to three weeks.
Today 50.5 million men and 59.5 million women in the U.S. are infected with an STD, and there will be an estimated 20 million new infections this year [source: Gholipour]. Chlamydia, gonorrhea, hepatitis B virus (HBV), genital herpes (HSV), genital warts (HPV), HIV, syphilis and trichomoniasis are the most common sexually transmitted infections among American men and women, with chlamydia and HPV accounting for the most infections [source: Gholipour]. Many STDs are considered "silent" because they don't have any noticeable symptoms, or they have minor symptoms such as genital itching. In parallel, more than two-thirds of doctors don't routinely screen their patients for these infections [source: Analyte Physicians Group].
Sexually transmitted diseases caused by bacterial infections, such as chlamydia, can be treated and cured with antibiotics. However, there is no cure for any STD caused by a viral infection, such as HIV, HPV and HSV, although symptoms can be treated and often suppressed. And while some STDs are lifelong infections, they aren't life-threatening emergencies. If you need treatment for an STD, you're better off seeing your general practitioner than going to emergency care.
Cutaneous abscesses — also called skin abscesses — are localized, red, swollen and tender infections below the surface of the skin. An abscess is basically just a small cavity that's filled with pus and contains the infection. If you've ever had a furuncle (also called a boil) or carbuncles (which are multiple furuncles joined together under the skin), you've had a skin abscess.
Abscesses typically form because of clogged sweat glands or inflamed hair follicles, and they're most often infected with Staphylococcus aureus. While an abscess will often drain on its own with warm compresses applied to the area at home, these lesions are some of the most common skin infections doctors treat. Abscesses that are stubborn and won't drain after several days of at-home treatment, those that are large (bigger than one-half inch, or 1.3 centimeters across), or in sensitive areas such as the face or groin should be evaluated by a physician. These infections may need to be lanced (opened, drained and irrigated to clean out the infection) [source: Doerr]. Abscesses that are caused specifically by community-acquired methicillin-resistant S. aureus (MRSA) are also typically treated with antibiotics.
If an abscess develops red streaking or is accompanied by a fever of 102 degrees Fahrenheit (38.8 degrees Celsius) or higher, the infection may be spreading, which means a visit to a general health care provider or an urgent care clinic is in order.
For various reasons, from perceiving you or your actions as a threat to food aggression and attention issues, dogs are responsible for 90 percent of our bite wounds. It's estimated that Americans suffer 4.5 million dog bites annually, and about 888,000 of that number visit an emergency department for evaluation and treatment [source: Garth et al.]. Cats account for most of the remainder of bite incidents, but other critters such as rabbits, guinea pigs, hamsters, and sometimes bats or other wild animals bite us. Most animal bites treated in the ER are dog or cat injuries, but it turns out that many bites don't actually need emergency treatment [source: Wedro].
Most injuries happen at home, many are minor — and it's suspected many are also unreported. A bite wound is considered minor if the injury is small, superficial, stops bleeding on its own with 10 to 15 minutes of pressure on the area, and is from an animal with a low rabies risk (such as a family dog). Minor wounds should be cleaned with soap and water and bandaged.
Dogs tend to crush when they bite, whereas cats tend to puncture. If an animal's bite breaks, punctures or tears the skin, clean the wound and call a doctor. Animal mouths aren't clean. There are more than 60 species of bacteria known to be found in a dog's mouth, for instance, and any wound that isn't healing or is developing signs of an infection should be evaluated by a medical professional [source: Garth et al.]. Large wounds, wounds with extensive tearing, deep puncture wounds or wounds that won't stop bleeding should be treated immediately.
As many as 8 percent of the patients visiting emergency departments in the U.S. are there for treatment of skin rashes, also called erythema. Most rashes, however, aren't life-threatening emergencies and can be treated at home, with a primary care physician or dermatologist, or, if needed, in an urgent care center [source: Murray]. If you have contact dermatitis from touching something like poison ivy or poison sumac, you'll want to rinse with water as quickly as possible. Additional treatment for rashes (including contact dermatitis) may include the use of calamine lotion, zinc oxide or an antihistamine.
Here's a quick, although not completely foolproof, way to evaluate your rash at home: If a red rash turns white when touched, such as in the case of contact dermatitis, heat rash and hives, it's probably not a medical emergency. Minor rashes often can be relieved with antihistamines and anti-itch creams. Some rashes, although rare, do need emergency medical attention and may be fatal without immediate treatment. Any rash that spreads rapidly, spreads across an area larger than your hand, blisters, swells or is accompanied by a fever needs immediate evaluation by a doctor.
Bee, Wasp or Yellow Jacket Sting
There you are, mowing your lawn, and the next thing you know, you've stepped on a bee. Bees, wasps and yellow jackets inject us with venom when they sting, and in addition to being painful, the area will typically also become itchy and swollen. The good news, though, is that almost all insect stings can be treated at home, and will heal in just a few days.
While wasps and hornets don't leave behind a stinger, bees do, and removing it — and the venom sack — is the first step in at-home first aid. Honey bees, for example, deliver their venom with a barbed stinger, and because it can take up to three minutes to pump all its poison into you, the quicker that stinger is out, the better [source: Stoppler]. Antihistamines and over-the-counter pain relievers will help reduce itching, swelling and discomfort, and applying ice to the area will also help ease pain and swelling.
Only about 3 percent of people develop hives, redness and swelling (anywhere on the body, not just near where the stinger stung), difficulty breathing and dizziness, which are signs of an allergic reaction. Mild allergic reactions are usually treated with an antihistamine and sometimes steroids. Less than 0.8 percent of those allergic reactions are life-threatening, systemic reaction called anaphylaxis, a condition that requires treatment with epinephrine. Any sign of an allergic reaction is pretty much the only time an insect bite needs immediate treatment [source: Stoppler].
Cold Symptoms: Coughing, Sneezing, Sore Throat
Only about half of visits to emergency departments across America are actual emergencies, needing rapid care [source: Robert Wood Johnson Foundation]. That means the other half of the people there are exhausting emergency resources that could probably be better spent on other cases. A major culprit needlessly driving people to emergency care: the common cold.
The hallmarks of the common cold are known to virtually everyone: coughing, sneezing and sore throat. On average, adults can expect to suffer through two to four colds every year; kids have it worse and may catch as many as eight colds in just one year [source: American Lung Association]. During 2009-2010, cold symptoms were the most common reason kids were brought to the ER (accounting for about one out of five visits). And make no mistake, a cold can make you feel utterly miserable. But unless you (or your child) develop breathing difficulty, chest pains or a fever of 104 degrees Fahrenheit (40 degrees Celsius) or higher, common cold and flu symptoms don't need emergency care [sources: CDC, Olisemeka].
Minor Cuts and Scrapes
Minor skin injuries such as cuts or tears (lacerations) or minor scrapes and abrasions don't require a trip to the emergency department. In fact, they probably don't even rate a call to your doctor.
Cuts and scrapes that are smaller than a half-inch (1.3 centimeters) in length, aren't on the face, don't go below the skin (no fat or muscle tissue is injured) and stop bleeding in less than 10 minutes (with pressure) are considered superficial wounds. Superficial wounds can be treated at home. First, apply pressure to stop the bleeding. Then, clean and bandage the area. That's it. If you have a standard first-aid kit in your home, you're already equipped to deal with superficial wounds without needing a medical professional.
However, if your cut is bleeding profusely, spurting blood, or continues bleeding nonstop after 10 to 15 minutes of firm pressure to the area, it qualifies as an emergency. Of course, any lacerations that are large or deep, that can't be cleaned or that don't appear to be healing after a few days should be evaluated by a doctor.
It's normal for your body temperature to fluctuate throughout the day, and you'd also consider it natural to run a fever if you've come down with the flu. Having a fever means your body is fighting an infection of some sort or another, from the mundane to the severe. On one hand, it could be a symptom of a cold or flu, while on the other hand it could be an early symptom of cancer. A fever may or may not need to be evaluated by a doctor, and even those that rise a little high may not be life-threatening emergencies — but how do you know?
OK, let's first look at the baseline. Normally a body's thermostat is set to 98.6 degrees Fahrenheit (37 degrees Celsius), and an elevated temperature isn't considered a fever until it rises above 100.4 degrees Fahrenheit (38 degrees Celsius) [source: ACEP]. Most fevers won't last longer than 24 to 48 hours, and most can be treated at home with acetaminophen or ibuprofen.
Fevers that rise above 103 degrees Fahrenheit (39.4 degrees Celsius) or that linger longer than 72 hours should be evaluated by your doctor. You may require antibiotics or at the very least additional testing to tease out the fever's source. Fevers registering 104 degrees Fahrenheit (40 degrees Celsius) or higher should be considered an emergency. Most fevers won't rise above 105 degrees Fahrenheit (40.5 degrees Celsius), but brain damage is known to occur when the body's temperature climbs above 107.6 degrees Fahrenheit (42 degrees Celsius) [source: Kaneshiro et al.].
Additionally, fevers sometimes occur alongside symptoms such as chest pain or difficulty breathing — two potentially life-threatening conditions that need immediate evaluation. And sometimes high fevers may cause convulsions, called febrile seizures; this is most common in children between the ages of 6 months and 5 years, with a fever of at least 102 degrees Fahrenheit (38.8 degrees Celsius). Anyone who has a seizure should be examined by a doctor, and any seizure lasting longer than 10 minutes needs immediate attention [source: NINDS].
How are ambulances dispatched and why do they cost so much? HowStuffWorks takes a close look at the world of ambulances.
Author's Note: 10 Reasons Not to Go to the ER
Urgent care centers are able to handle several common conditions often seen in ER waiting rooms, such as sprained ankles, fevers or UTIs. Yet I think a lot of us overlook the benefits urgent care centers offer, at least when they're available to us (not everyone has access to local alternative care centers, or one that's open during the wee hours). We automatically weigh our three options: whether the condition is minor enough to grab a bandage or a few aspirin and go about the day; whether it's bothersome or scary enough to call for a doctor's appointment; or whether it's a life-and-death situation that needs the ER. The urgent care center option needs to be added in there somewhere.
More Great Links
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