How are you supposed to decide where to get care for emergent conditions? Where is the dividing line between “just book a clinic visit”, “head into urgent care when you get a chance”, and “go inmediately to the ER”?
So this is a question I’ve always struggled with and it makes me feel very dumb especially because I literally am a EMR. This feels like something I should know. But at the same time I have also called to book a clinic visit before and had the scheduler tell me to go to the ER immediately only for it to wind up being nothing.
Certain things are obvious of course. Like if I need stitches or there is other major trauma then I know to go to the ER. If it is something like a concerning infection then I know urgent care can sort me out. For a skin rash that’s probably a clinic visit. If urgent care is closed and it can’t wait then default to the ER. But there are also the issues where I genuinely don’t know on what side of the line they should fall. This is especially an issue for things that have been going on for a while which I know could be severe but almost certainly aren’t.
For example (not asking for medical advice) I’ve been having repeated extended periods of heart palpitations for the past 2 weeks. At first I just chalked it up to screwing up my anxiety med schedule while I was on vacation because my med situation does cause heart palpitations if I screw it up. So I didn’t think much of it at first but now I’ve been back on my meds properly for 2 weeks with no change. So, that’s cardiac symptoms which in a patient would make me tell them to immediately go to the ER just to be safe. But at the same time it’s been going on for 2 weeks and it’s probably just some vitamin deficiency or something so it probably wouldn’t kill me to wait a week for a clinic appointment (no walk in clinic here). Do I split the difference and go to urgent care? It’s like schrodingers medical issue, it’s both the worlds most benign thing and a symptom of immediate death until someone looks into it, so how do I know who should open that schrodingers box?
It seems like there has to be some easy dividing line on how to know which one to go to that I just don’t know.
Edit: In USA, because that probably matters here.
If it’s new shortness of breath or chest pain , particularly the crushing variety that feels like something is sitting on you, do not pass go, do not collect money, straight to the ER. Same goes for sudden severe lower back or abdominal pain or sudden heavy bleeding out of your orifices (more than a super maxi-pad full every two hours if you’ve got that genital configuration). There’s a few other little things like a continuous erection more than 4 hours. Also you should learn the signs of a stroke (Google “stroke FAST”). If you’re not sure, look up the local ERs number (not 911) and ask for the “triage nurse” and ask them.
If it’s been going on / steadily getting worse for over a month it can (probably) wait one more week if that’s all it will take to see your primary care physician or see a specialist.
If it’s sudden but you know exactly what you did like if you pulled a muscle or sprained a joint at work or cut or burned your arm while cooking (I specify arm, if you cut or burn your hand, face, or foot, measure how big it is and call that triage nurse, and if it’s your genitals just go to the ER) or if you forgot to pee after sex or did it with somebody sketchy and now it hurts to pee, go to the urgent care. Or if your petri dish of a preschooler brought home something and you’re not sure if it’s strep but you almost definitely need a note for work. Or if you have an old cut but now it’s looking puffy and oozing weird liquids (but it’s still localized to that one little area, you don’t have a fever or anything). If you can look at it and already have a general laymans idea of what they’re gonna do to it, go to the urgent care.
Great criteria. Another “straight to the ER” one is loss of consciousness; people get knocked out in movies all the time so it’s easy to assume it’s fine, but it’s not.
I work in 911 dispatch, it drives me nuts how many people lose consciousness for various reasons, and then when they come to they say they’re fine and don’t need to be checked out.
There’s maybe some very narrow exceptions for people with known conditions that they’re already managing with the help of a doctor and they know exactly what’s causing it.
But in general, if you’re losing consciousness that’s a bad sign and you need to see a doctor about that ASAP
Oh yeah I was thinking about adding head bumps but forgot / wasn’t sure where to add it.
Losing consciousness for any reason = ER. A friend passed out during dinner and we weren’t sure what to do, so we called the triage nurse and they were like “ER now!” (He was fine, they never figured out what happened and it’s never happened again, but it’s definitely stayed with me.)
It’s happened to me a while back because of a likely electrolyte imbalance. I actually passed out in the hospital urgent care because I had gone in for feeling so shitty. Then they call an ambulance to take me from the urgent care doors to the ER doors across the parking lot. Of course the first thing they did before the ambulance even got there was put a saline IV in so by the time I got to the ER I felt perfectly fine and the tests didn’t find anything. Doc said I probably just had low sodium. That’s also where I learned for the first time that SSRIs sap sodium from your body which seems like something they should tell you when they put you on them.
How much for the ambulance across the parking lot? I would crawl rather than pay.
Lol. $1200. That was literally the minimum because the invoice listed 0 miles and no supplies used. If they would have let me crawl then I would have.