When should you go to the emergency room? Doctors provide guidance
Two emergency room doctors discuss the pros and cons of emergency care for parents, older adults and summer vacationers in northern Minnesota.
PARK RAPIDS, Minn. -- Sometimes, when you experience an injury or a symptom of illness, you’re not sure whether you should go to the emergency room or not.
According to ER professionals, you shouldn’t worry about that. Going in to be checked, just in case, is never the wrong decision.
Dr. Joseph Corser, chair of the emergency department at Sanford Bemidji Medical Center, has 35 years of emergency room experience. He has eight emergency medical providers working with him, with two more joining the department in late July and early August.
Forum News Service asked Corser whether he has a sense that people are using the ER too much when they shouldn’t, or that they’re not using the ER when they should.
“I would not agree with either of those statements,” he said. “I think people are using the emergency room appropriately. Sometimes, when symptoms are present, it’s difficult to know whether a patient has a significant illness or not. So, I understand completely patients who come to the emergency room with a concern about a symptom and it doesn’t turn out to be present.”
However, he said, this shouldn’t deter them from seeking medical attention. For example, if a child has abdominal pain, vomiting and diarrhea, it’s often caused by a gastrointestinal virus and the treatment is to rest at home, take fluids and wait a couple days to get better. Again, sometimes the child has appendicitis, and the treatment may include surgery to remove the inflamed appendix.
“I can say ‘It’s just a virus,’ but that doesn’t make the abdominal pain any less distressing or the vomiting any less concerning than with the child that does have appendicitis,” said Corser. “We all have a need to try and decide what’s wrong,” and treat accordingly.
That’s what the ER is for
Corser stressed that emergency rooms have tools to diagnose what’s wrong, including labs and imaging technology. “We can check their blood count and do an abdominal exam, and then repeat that abdominal exam in a little while if we need to,” he said.
Corser acknowledged there are many minor injuries, like sprained ankles, where people can take care of themselves. Also, many headaches, bellyaches and coughs will get better on their own.
“But occasionally, the child will have a bacterial pneumonia that needs an antibiotic, or gets better quicker with an antibiotic,” he said. “Sometimes the kid will have a tonsillitis that can cause a periodontal abscess, something like that, that needs to be treated or decided upon. And we continue to treat streptococcal pharyngitis. There are a bunch of those common things that have common symptoms like a sore throat or a cough, that we can figure out at the emergency room.”
Fever: To treat or not?
As a general guideline, Corser said that if someone with a viral infection has a low fever and can take fluids, they can wait a couple days to see if it goes away by itself. More concerning, he said, is a fever in a child less than 1 year old, a high fever lasting more than 24 hours and changes in behavior.
“A lot of it depends upon parents’ judgment and experience,” said Corser. “We’re more than willing to help with that.”
Dr. Larry Kobriger, a full-time ER physician at CHI St. Joseph’s Health in Park Rapids, is also ambivalent about parents bringing feverish kids to the ER.
“I think they’re going to tell us as doctors, pretty soon, not to even treat fever, because if we leave it alone, supposedly the kids are sick one day less,” he said, emphasizing that the problem isn’t the fever itself, but the infection that the child’s body is fighting.
“Right now the general feeling is, it has to get up to 108 to hurt kids,” said Kobriger. “But I’ve never seen it. Even febrile seizures are horribly scary, but they don’t hurt them.”
Nevertheless, as a parent, he understands wanting a child to feel better – even if treating the fever means they’ll be sick a day longer.
However, he said that if a child is struggling to breathe, or having trouble eating because they’re short of breath, they should be brought in. “You don’t want to mess with that,” he said.
Kobriger added that it’s different where older people are concerned. “If they develop a fever and are confused, they should be seen instead of letting it run its course,” he said. “They may be septic.”
Overuse of the ER
Kobriger recalled several issues, mostly concerning parents and their children, that often lead to unnecessary emergency room visits.
“We see a lot of children that bump their head,” he said. “They get this goose egg and it looks scary, and they even throw up a couple times. The large majority of those kids will just get back to normal if you just give them time.”
Another example is so-called heat stroke. “If they really had heat stroke,” said Kobriger, “they’re not gonna come looking into the hospital and tell us. They may have some heat exhaustion and some mild dehydration, but if they’re not vomiting, they just need to rehydrate themselves.”
He hinted that every tick bite does not need to be seen, especially if the bite is brief and leaves only a small red spot. “It’s just a little immune reaction,” he said. “It’s not that target lesion that people fear when they get Lyme disease.”
Kobriger also noted that unvaccinated people are at risk of getting COVID-19, but “the more we see it, the more we realize there’s not a whole lot to do about it, unless you need help breathing. You’re just gonna have to ride it out.”
On the flip side, Kobriger mentioned a few scenarios where you should go to the ER sooner rather than later.
After an accident, people feeling general soreness probably don’t need to be seen, he said. “But if you’re hurting in one spot after an accident, … that may be a fracture that needs to be seen.”
It’s also a bad idea to wait 12 or 24 hours to come in after having a bad cut. “If you think you might need to have a stitch or two, then you need to come in and have that done while it’s fresh,” Kobriger said.
Summer in the ER
Corser said he would expect more ER visits this summer because so many people are vacationing in northern Minnesota.
“Everybody’s been cooped up for the last couple of years because of the COVID crisis,” he explained, also noting that the Canadian border remains closed, forcing many travelers to move their vacation plans southward.
Recreational activity carries risks. “We see a lot of physical injuries,” Corser said. “People are skiing and running and biking and doing all kinds of recreation, and that leads to wrist fractures and leg fractures and ankle sprains and clavicle fractures, and those kinds of things.”
Kobriger said he thinks they’re seeing more ATV accidents than usual, because “people are getting their frustrations out from being penned in for so long.”
He also noted that there seem to be a lot more psychiatric issues lately, such as the police bringing in people believed to be suicidal. “Police are following Facebook and online chatter,” he said. “If they get somebody that puts a few comments on there like, ‘Say goodbye to my family,’ they have to follow up on that.”
Kobriger said the ER sees a lot of bee stings from this time of the summer on. “The majority of them don’t really need to be here,” he said. “If you get stung somewhere and you have a reaction somewhere else on your body, come in. But if you’re swollen just where you were stung, even if it’s all the way up your arm – if you get stung on your toe and your whole foot is swollen – that’s the way it goes. There’s not a lot we can do about that.”
Once injured, Corser said, people basically have two choices: urgent care or the ER.
“I think it’s a little cheaper to go to urgent care,” he said, “because they don’t need to keep as many physicians and nurses on staff, and don’t have access to all the imaging and laboratory capabilities in emergency departments.”
Corser said if you have an ankle injury with no obvious deformity and you can still put weight on it, but you still want to be seen, urgent care might be the place to go.
“But if you have an injury to the wrist, the elbow, the shoulder, and an obvious deformity, where the bone doesn’t appear to be in its normal shape, then I would suggest coming to the emergency room,” he said, noting that the ER can provide adequate pain meds and even sedation while setting a broken bone or putting a dislocated limb back into joint.
He also noted that ER providers see a lot of tick-borne and mosquito-borne illnesses during the summer.
“They require some additional investigation to try and sort out whether that person does or does not need to be treated,” said Corser.
Longer ER stays
“Because of the COVID pandemic, we’ve been doing a lot more evaluation of many of those febrile caused illnesses, looking and hunting for COVID, so we can make certain we break the chain of transmission,” Corser said. “That’s requiring a longer stay in the emergency department, and so we’ve had longer stays in the waiting room, and a lot of people are pretty frustrated by that. I can understand that completely.
“But we’re working as hard as we can to try to take care of everybody, so that we can do that safely and confidently. It’s just taking a little bit longer.”
He encourages everyone to be, well, patient with the process while the emergency department works on strategies to expedite patients’ ER experience. These include bringing on additional staff, streamlining their facilities to treat more patients and improving the process of evaluating whether people need to be admitted to the hospital or can be sent home.
On the public’s side, he urges everyone to be vaccinated against COVID-19. Even with new strains breaking out, he said, the immunization will help prevent severe cases that can lead to hospitalization.
Corser also urges patience during long waits in the ER, because people in the waiting room may not know that ambulances are arriving with people in crisis. “We’re trying to work through that as best we can,” he said.
Meantime, his general advice is to establish care with a primary care provider, keep their immunizations up to date, and follow basic precautions like wearing sunscreen, insect repellent, seat belts or helmets while on the road and life jackets while boating.
He said tick bites can be prevented by tucking pants into socks, wearing light-colored clothing and treating clothes with permethrin. He also advised teaching kids to swim.
“All those things are worthwhile,” said Corser.
ER always an option
Bottom line, Corser said whether or not to visit the ER is a personal decision.
“There’s no situation where I can say, ‘Don’t come to the ER for that,’” he said. “Because, again, we don’t know what the answer is yet. If you have a concern, coming to the ER is always a reasonable thing.”
Besides visiting urgent care, however, other options include calling your regular physician to describe your symptoms and seek their opinion; calling the public health nurse; and calling urgent care to discuss your symptoms and get their advice.
Many health care systems, including Sanford, have a MyChart app that allows patients to access their medical records online. Patients can also message their provider through these apps, or fill out an online evaluation form on the provider’s website.
“I don’t want to discourage anyone from coming to the emergency room,” Corser said, “because there are some things that are very subtle and don’t have much in the way of symptoms that require a big evaluation.”
Some of the “magic words” that ER doctors are always concerned about, but that may seem like subtle signs to many, include lethargy, fever combined with confusion and just not acting normally.
Meanwhile, those gastrointestinal symptoms that make people really miserable are often a sign of something that will go away by itself in a day or two. But even then, Corser said he wouldn’t tell them not to come to the ER.
“Maybe they’re dehydrated; maybe their sodium is out of whack; maybe we need to give them some potassium supplementation; maybe they have a bacterial illness,” he said. “I don’t know what’s wrong with them until we have a look at them.”