Summer is fast approaching and it is already proving to be a very busy season in emergency rooms across the country. Days full of swimming, sports, alcohol, and hot weather create a perfect storm of conditions for accident and illness. While nobody anticipates an ER visit, a few simple decisions, as well as a little bit of advance planning can make a world of difference as to how your visit to the hospital will play out.
Here are five simple tips, based on my 10 years of working in the ER, which will make a huge difference to both the speed and safety of any ER visit:
1) Always have a wallet card
Every patient, no matter how young or old, should have a wallet card that lists his or her health history. Often, during the panic of an ER visit, patients are either physically unable to tell me their past history, or they are too anxious to remember key details.
This is crucial both to reducing delay in the ER, and to making your visit safer. I could tell you horror stories of patients who received unnecessary radiation in the form of CT scans, along with hours of delay, being investigated for appendicitis, merely because they forgot about their childhood appendectomy. I could tell even worse stories about patients with anaphylactic shock in the ER because they were unable to tell me about their penicillin allergy.
Health wallet cards should contain the following information:
- Name, address, date of birth, insurance information
- Next of kin, who to contact in case of emergency
- Past health conditions -- since birth (don't leave out that childhood asthma!)
- Past surgeries -- since birth
- All medications, including recent short term treatments
2) Pre-treat your symptoms
Many patients choose not to treat symptoms prior to coming to hospital as they fear that masking their illness with medication will lead to them not being taken seriously in the ER. As long as symptoms are well documented prior to your visit, nothing could be further from the case. In this vein, make sure you have basic items like a thermometer at home -- in my assessment of a patient, I take a documented and measured fever (oral temperature greater than or equal to 100F or 37.8C) much more seriously than I do a patient who tells me they felt warm, but never measured their degree of fever.
Pretreating common illnesses helps ER staff to know how well you respond to first line therapies and can also shave hours off your visit, as we will not have to wait for your fever to go down or for your allergic rash to subside.
My top three medication recommendations for pre-treatment are:
a) Fever -- treat with acetaminophen (650mg in adults or 15mg/kg in children every four hours) and/or ibuprofen (400mg in adults or 10mg/kg in children every six hours)
b) Vomiting -- treat with dimenhydrinate (gravol). This comes in suppository form in cases where symptoms are too extreme to tolerate a pill by mouth. (50mg in adults or 1mg/kg in children every four hours)
c) Allergic reaction -- treat with diphenhydramine (50mg in adults or 1mg/kg in children every four hours)
3) Bring a translator
Many years ago, on an overnight ER shift, I saw a male in his mid-20s, who spoke only a few words of English, and was unable to explain his symptoms to me properly, or even to tell me what his first language was. The only words he was able to utter, over and over again, were "penis... go tick, tick, tick." Despite a thorough attempt at history and examination, due to the language barrier, I never did figure out just what was making this poor man's penis "tick." To this day, I wonder what awful diagnosis it was that I might have missed that night.
In today's multicultural society, it is increasingly common for us to see patients like this, where language difficulties present a primary obstacle to diagnosis and treatment. I am continually surprised, however, by the proportion of such patients who bring no friends, relatives, or language guidebooks to assist them with communication during an ER visit. In these situations, the best-case scenario is a considerable delay in treatment and diagnosis, and often, in worst cases, the resulting miscommunication can lead to missed or incorrect diagnoses, sometimes with deadly consequences.
If you have friends or family who do not speak English, accompany them when they visit the ER. And when this is not possible, make sure they have a pocket phrase book of some kind that will allow basic communication, as well as the identification of their language of choice.
4) Bring your assistive devices
One of the pet peeves of every ER physician is the patient who comes in with a complaint related to their eyes, who complains of diminished vision, but who forgot to bring their glasses to the ER. One of the most important tests to check your eye health is your visual acuity, and in these cases, it is impossible for me to determine whether your terrible vision is due to your illness or injury, or simply due to you not wearing your glasses. So always bring corrective eyewear to the ER.
Similarly, if you require a special brace to walk, or a hearing aid to hear -- bring these with. We ER physicians need to know how today's function in the ER compares to your baseline function at home -- and that requires the aid of whatever devices you use regularly in your day to day life.
5) Stick to the real emergency
Frequently I see patients who present with an emergency issue, and at the same time try to sneak in a reassessment of a chronic condition. This can dangerously distract and delay an ER physician, like myself, from recognizing the acute emergency condition that you actually came to the hospital to treat. I remember treating a heart attack patient who considerably delayed his heart attack diagnosis due to his insistence that I first hear about and reassess his long-term issues with osteoarthritis. Clearly, not a wise decision, and if I had not eventually forced this patient, after an hour spent at x-ray, to talk about the reason for his visit being today versus any other day, I might have missed a deadly outcome.
Additionally, even if one doesn't have any acute illness to identify, the ER is a terrible place to seek care for chronic, ongoing, medical conditions. We don't have access to investigations and treatments done by your regular physicians, and we don't have the ability to see you again to assess your response to changes we might want to make in ongoing therapies. There is a good chance ER physicians can actually do you a lot of harm in these cases, by repeating your previous tests unnecessarily, and prescribing treatments that interact negatively with others you've previously received.
And there you have it. Thank you for reading and have a safe and healthy summer!
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