ER

I would like to share some information regarding the Emergency Room. This article may be a long one because of so many aspects to consider.

I will begin with saying the ER doctors, nurses, social workers, techs, medics, secretaries, and students work in the ER because they want to. The staff members in many ER’s across our nation are dedicated to caring for the patient who is experiencing an emergency. These people are highly skilled and specialized. My hat is off to America’s ER workers!

What is an emergency? Anything that affects the A,B,C’s of our body.

A= AIRWAY

B=BREATHING

C=CIRCULATION

If you have lost your airway, you can not breathe, and if you can not breathe, it will take about 4-10 minutes to die.

If you sever an artery, you have about 2 to 4 minutes to get the bleeding stopped. Because of the break in the circulatory system, the vital organs will not receive oxygenated blood and the blood will not be carried away to be cleaned; end result, the vital organs shut down and death usually follows.

Remember ABC’s and you will be able to triage a lot of injuries.

Broken bones are an emergency. The broken bone has the potential to sever an artery, vein, or nerve. You can apply the ABC’s here. Another problem with broken bones is that they have the potential to throw a fat clot. If any organ is deprived of oxygenated blood the organ will shut down and die.  

Another true emergency is any problem concerning the neurological system. We are due to our nervous system. The neuro system includes the brain, spinal cord, and peripheral nerves throughout the body. Once a nerve is crushed, cut, or pinched the communication to the body part from the brain is lost. Thus, no movement will occur. Excessive swelling can cause serious neurological problems. A hard bump on the head can cause swelling or worse, bleeding inside the brain or cranial space. Remember the skull does not expand. Pressure builds and neurological problems will certainly ensue. Be aware the swelling/bleeding can occur a day after the time of the injury. This is called a slow bleed. This is an absolute true emergency. Again, depending on where the injury is, function to the body part is lost or death may occur.

People on dialysis usually go to an outpatient setting, but sometimes will have to come to the ER for a treatment. Electrolytes can be too high or too low. Toxins can build up quickly and may cause all kinds of problems.

The flu can be an emergency especially if the patient is young, old, or if the immune system is compromised. Just like the dialysis patient, having the flu can deplete your electrolytes which can be replaced easily by an IV in the ER.

Any prenatal bleeding or excessive cramping is not normal. Typically a pregnant woman will go to the ER and then will be transported to the OB department to receive care from the OB experts.

Psychiatric emergencies include anyone feeling suicidal with a plan and positive intent to carry out the plan. Anyone feeling homicidal should be hospitalized. Any mental status change requires an ER visit. If a loved one is demonstrating bizarre behavior for the first time then it time to be seen in the ER. Anyone who has taken an overdose and is still alive must go to the ER.

Any violent attack to your person especially rape, please go to the ER. They have rape specialists there to help you through this terrible event. They will also hook you up with the police if you want to press charges. The social worker will give you people in the community who can help with the aftermath of this situation.

Unless the medics scrapped you off the pavement you must call your insurance company to be approved for the ER visit. Most insurance companies will give the patient 24 hours to notify them about the emergency. This is absurd, but that’s how the medical system is set up. Insurance companies will look for any loop hole they can find to deny the claim. If you, the patient can’t call, make sure someone in your family contacts the insurance company. This will prevent many, many problems down the road. Dealing with a severe injury or illness and having the hospital hunt you down for payment for services rendered can be hell. The ER doctors have specialized bill collectors because the ER doctors care for a large portion of the population who has no insurance or is indigent. ER doctors want to be paid just like anybody would after performing his or her job. If you have no insurance, job, or money make sure to speak with the business office to apply for charity. Most hospitals have a charity program.

If you have ever been in an ER you know how busy the ER workers are. The triage nurse will place you in the waiting room or will immediately take you back to be seen. The nurse will use the ABC method to triage you.

Center. If you don’t have a family doctor then you need to get one. The ER doctors do one thing well. They stabilize you. That is their job. Once stabilized, you are either admitted to the hospital or you are given instructions to follow up with your family doctor. So you can see how important a family doctor can be.

Chronic illness is best treated by your family doctor or specialist. If the care is comprehensive you won’t have to visit the ER very much if at all.

If your baby gets an ear infection over the weekend go to an Urgent Care center. Even if your pediatrician has an ‘on call’ system, most doctors will not prescribe antibiotics for the infection unless they have seen the ear for themselves. If anyone has experienced a baby with an ear infection you would probably agree with me that it seems like an emergency. But if you apply the ABC method you can easily triage to Urgent Care.

Another large group of people who come to the ER and really should not are the people in non-malignant chronic pain. People in this category will need to set themselves up at a pain clinic. These clinics are widely accessible. The doctors in these clinics have strict rules that must be followed or you will be kicked out of the program. So the ER doctors pick up the slack and they are not too happy about this either. If a person with chronic pain comes into the ER over the weekend and or late at night the ER doctor will prescribe one or two days worth of pain medications and they will tell you to follow up with you pain doctor. If the number of pills is not acceptable to the patient the doctor will suggest detox. The DEA is coming down hard on doctors who prescribe these drugs carelessly. One more thing, think where this person fits in the ABC triage system. You are right! This person will be way, way, way, down on the list of patients to be seen. The person seeking pain medication will usually wait for a very long time to be seen. Tempers fly and this can turn into a violent scene before you know it. Most ER doctors and staff attend combat education for this reason.

Most cuts on the skin can be handled by an Urgent Care Center. If you get cut during the weekend or at night and you think you may need stitches go to the ER. Any deep cut will need to be cleaned and closed within 24 hours or the doctor will not close the cut for fear of infection. If you wait too long to be seen your wound will have to heal from inside out which takes a very long time. Cuts can be tricky to decide where to get medical help. Apply the ABC method for triage. If you have a gusher, stop the bleeding and call 911 or go to the nearest ER. If you become injured with a penetrating object, leave the object exactly where it is and call 911. The object can place pressure on an open blood vessel which will prevent a bleeding emergency. It is best to leave the object in for the surgeon to take out.

Sprains and strains can be handled at an Urgent Care Center or your doctor’s office.

Acute (meaning rapid onset) of abdominal pain will require an ER visit. The abdomen is filled with vital organs and a lot can go wrong with the GI system. The ER has access to all the major testing equipment such as the CAT scanner and MRI machine. Theses two tests can rule out a problem or diagnose you on the spot.

Chronic problems with your gut can be handled in your doctor’s office.

I hope I have given you some valuable information on how to triage emergencies. Use the ABC triage method to know where to get your medical help. If in doubt, always side with caution and go to the ER.

Be safe and stay well!

Tags: ABC"S of triage, Family doctor, Triage yourself, urgent care