10 Injury Treatment Priorities at the Emergency Room

Patients who come to the emergency department complaining of non-specific pain can be tricky to triage. This type of pain is different from that caused by an identifiable source, such as a patient complaining of chest pain, back pain, stomach pain or a headache. Non-specific pain could be caused by any number of reasons related to the body's 10 main organ systems, from the skeletal system, the nervous system or the muscular system. It could also be psychosomatic in some instances. Identifying its cause can be a complex puzzle.

This is one instance where getting an accurate medical history, either from the patient, through patient medical files or from the patient's primary care physician, can help determine if the pain has been a chronic problem or is acute. A solid understanding of the patient's medical history will also help emergency room staff understand if the patient has another illness that may contribute to this pain or if the pain has been previously treated and how. It also helps doctors and nurses flag patients who may have previously visited the ER in an effort to solicit pain-relieving medications for an addiction rather than for pain treatment.

Patients who complain of a sore throat should expect to get comfortable in the waiting room during their ER visits. Two of the more common diagnoses made in the ER are acute upper respiratory infections and acute pharyngitis, but neither are life-threatening conditions. While a sore throat is uncomfortable, it's often caused by a viral or bacterial infection and treated either by antibiotics -- if it's bacterial -- or with time and rest if it's viral.

"A sore throat is typically not urgent or an emergency, but occasionally it can be. For example, there could be an abscess in the throat," explains Dr. Niels Rathlev, chair of the department of emergency medicine at Baystate Medical Center in Springfield, Mass.

When it's cold and flu season, it might feel like you can't escape from people coughing around you. Coughs from colds and flu are caused by bacterial or viral infections and generally clear up on their own in a few days or weeks. Some coughs, though, may be symptoms of more serious problems.

But a cough alone is not a serious medical emergency. While most patients with coughs who visit the emergency department are diagnosed with acute upper respiratory infections, coughs that are raspy or sound a bit like a barking seal could be indicative of croup, and patients with shortness of breath and wheezing in addition to a cough may be having an asthma attack. Whooping cough, an illness with severe coughing is a high-contagious condition that requires medical attention. Coughs that are accompanied by blood or bloody, frothy or thick mucus are not normal and could be signs of a medical emergency, such as pulmonary edema or lung cancer. Furthermore, coughs with severe chest pain could be a symptom of a pulmonary embolism, tuberculosis or congestive heart failure.

Symptoms associated with back pain, not including lower back pain symptoms (those are considered separate and rank low both in reasons why people visit the ER and in priority during the triage process), may be caused by injury to or inflammation of soft tissue, tendons, muscles, ligaments, bones, joints, nerves or discs. Back pain and is commonly caused by a sprain or strain, unintentional injury, fall or accident, or even aging or a degenerative health condition. Most often, patients who visit the ER with back symptoms are diagnosed as a sprain or a strain, but depending on if there are other symptoms (fever and burning during urination combined with back pain could indicate a kidney infection, for example) back pain is a minor priority in the emergency room.

The mean temperature of patients who visit the emergency room complaining of a fever is 100.6 degrees Fahrenheit (38.1 degrees Celsius) [source: McCaig and Burt]. Fevers that are below 102 degrees Fahrenheit (38.8 degrees Celsius) are usually considered to be a mild symptom, often caused by an infection that the body is trying to fight off, such as a cold or flu.

But when a patient has a fever, plus additional symptoms that include a stiff neck or confusion, which could indicate encephalitis or meningitis, or the fever climbs above 103 degrees Fahrenheit (39.4 degrees Celsius) or lasts for more than two days it, could be a medical emergency. The chances of most fevers climbing over 105 degrees Fahrenheit (40.5 degrees Celsius) is low, but if a fever goes as high as 107.6 degrees Fahrenheit (42 degrees Celsius) it puts the patient at risk for brain damage and should be treated immediately [sources: Cleveland Clinic; MedlinePlus].

The cause of a patient's vomiting, much like many of the other reasons for ER visits, can be complicated to diagnose. Reasons range from mild, such as a viral infection, a migraine headache or motion sickness, to serious, like food poisoning or food allergies, to life-threatening, such as when it's a symptom of a brain tumor. Doctors will look closely at any co-existing conditions and symptoms, as well as conduct diagnostic tests like blood work, urinalysis and X-rays to help determine the cause of the problem. Because of the potential for vomiting to be a serious condition, it is given mid-level priority in the emergency department.

Most people will have a headache from time to time. Others may suffer from tension, cluster or migraine headaches. But a headache that happens suddenly, causes visual disturbances, confusion or seizures is considered high-risk, as is a headache that is more intense than any the patient has previously experienced. If it's the worst headache of your life, you'll have priority over a patient who is known to have, for example, migraine headaches.

Severe headaches can be caused by serious, sometimes life-threatening, reasons. For example a subarachnoid hemorrhage -- bleeding between the brain and its surrounding tissue -- is sometimes caused by a head injury or a ruptured cerebral aneurysm and is a critical condition. Severe headaches may also be indicative of a stroke or meningitis, two serious conditions that are given priority in the emergency room.

Abdominal pain is the over-arching term for symptoms that include stomach pain, cramps and spasms, and according to the Centers for Disease Control and Prevention about 17 percent of patients who visit the ER with these complaints are diagnosed with a serious condition [source: Meisel].

The cause of abdominal pain can be caused by something as mild as indigestion and menstrual cramps or as urgent as appendicitis and angina. Some life-threatening conditions like a heart attack, aneurysm or ectopic pregnancy may also feel like stomach pains. Because the condition could be life-threatening, patients with these complaints are given high priority. Diagnosing the cause of abdominal pain is often a puzzle that can require multiple diagnostic tests, such as blood work and CT scans. In the end, the three most common causes of abdominal pain are no acute condition, followed by renal colic (pain usually associated with kidney stones) and intestinal obstruction.

Chest pain and shortness of breath are high priorities in the ER, and often it's the patient's co-complaints that will determine if chest pain trumps shortness of breath or vice versa when determining patient priority.

Both conditions can be caused by severe or minor problems. Chest pain can be a sign you're having a heart attack or have a pulmonary embolism (a blood clot in the lung). But it could also be a symptom of heartburn or gallbladder inflammation, as well as injured ribs, cancer or a panic attack. Similarly shortness of breath can be caused by several medical conditions, including life threatening emergencies like a heart attack, pneumonia, severe asthma attack or allergic reaction to less urgent problems like a panic attack.

When it comes to chest pain and shortness of breath, the priority is going to depend on any other complaints, as well as the age and sex of the patient, explains Dr. Hedayati. "A 60-year-old man suffering from shortness of breath takes priority over a 20-year-old woman complaining of shortness of breath."

Although life-threatening injuries aren't the No. 1 reason patients find themselves in the emergency room, or even in the top 10, these are the patients who will receive first priority by the emergency staff.

"The obvious first-priority patients are those with multiple trauma, gunshot or stab wounds, those who've been in motor vehicle accidents, those with obvious stroke or who are having a heart attack with a specific pattern on EKG," explains Dr. Rathlev. Patients in shock or who have unstable vital signs -- extremely low blood pressure, extremely high pulse -- or who have a change in their mental status or have sudden confusion are also given first priority.