It’s two in the morning… there are long lines, overcrowded spaces, tired staff.
No, it’s not the hottest club in town — it’s your local Emergency Room. As an ER doctor who has worked many of these nights, I can personally attest to what studies confirm: ER visits are at an all-time high.
So when is it an emergency that would benefit from a trip to the ER, and when is it likely OK to wait until the morning to see your doctor? Here are eight general scenarios that might make you wonder whether or not you should go to the Emergency Room. If you find yourself facing one of these situations, or something similar, read on to find out the best course of medical action.
1. You’re fixing yourself some veggies and slice your finger. You’ve cleaned the cut and the bleeding has stopped, but your last tetanus shot was four years ago. Do you need another?
Tetanus shots may be good for up to 10 years, but I usually use a conservative cut-off of five years for my patients, especially for dirty or puncture wounds. Keep in mind, though, if you do need stitches (the bleeding won’t stop or it’s on a body part where cosmesis is a concern), you should go right away. Doctors usually won’t close most wounds after eight to 12 hours because the risk of infection is too high.
2. It’s Friday night, and you realize you just took your last prescription pill. You call the pharmacy, but the pharmacist informs you you’re out of refills on your prescriptions. What should you do now?
Call your doctor’s office. Even if he or she isn’t working, almost all doctors’ offices have a covering doctor on-call at night and on weekends who can easily call in a refill for you and save you a visit to the ER.
3. You have a mild allergy to strawberries and you unknowingly ate strawberry yogurt. Now you’ve broken out into hives. Should you go to the ER?
Try taking Benadryl and Pepcid over-the-counter first. This is the first-step treatment that I would give you in the ER. However, if you have trouble breathing, notice swelling of your lips or tongue, develop a change in voice, find it hard to speak or swallow, or you’ve had a severe allergy of any kind in the past, call 911 or go immediately to the ER.
4. You were at a picnic earlier in the day, and now regret eating that coleslaw that had been baking in the sun. You’ve vomited twice and then had an episode of diarrhea. Time to see the doctor?
Not necessarily. If you don’t have any chronic medical conditions, haven’t traveled somewhere exotic recently, haven’t taken antibiotics or started any new medications, and only have mild abdominal cramping, you can likely treat this at home with lots of water and clear fluids and rest. If, however, you can’t keep up on your fluid intake or the pain becomes severe or localizes to one point in your abdomen, it might be necessary to make a trip to the ER.
5. That lower right molar is really hurting you tonight. Will the ER doctor be able to fix the cavity?
If you have a dentist, you should call him or her in the morning. ER doctors generally aren’t trained and don’t have the equipment to definitively treat dental cavities. But if you have a fever, facial swelling, or any difficulty speaking or swallowing, consider going to the ER, as the infection may have spread.
6. A rash has been on your arms for a couple of days. Can the ER doctor help you tonight?
My job in the ER is to diagnose rashes that are dangerous, but not necessarily to determine what might have caused a benign one. If your rash doesn’t involve any mucosal membranes such as your mouth or your genitals, is not on your palms or soles, doesn’t hurt, doesn’t look like blisters, and you otherwise feel well, it’s unlikely that a trip to the ER is necessary.
7. You feel the beginning of a urinary tract infection. Do you need to see the doctor right now?
If you’re otherwise healthy, don’t have pain in your abdomen or back, and don’t have any fevers, you can likely wait until the morning.
8. You called your doctor’s office to move up your next appointment. The office assistant tells you that sooner appointments aren’t available and if you’re concerned about anything, to go to the ER.
Take what your doctor’s assistant says with a grain of salt. Often, the person answering the phone isn’t medically trained, but is trained to be conservative and advise you to seek emergency care. Ask to speak to your doctor directly, and if he or she isn’t available, another provider at the office. Most hospitals also have an around-the-clock phone line you can call and speak to a provider, which might help you avoid a 2:00 a.m. visit to the ER.
With all this said, always use your judgment; if you feel a trip to the ER is needed, you should absolutely go! We are always open 24/7 and always see everyone who comes through the door.
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