Health & Fitness

What Merits Medical Attention?

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More than 136 million people visit an emergency room each year, according to the Centers for Disease Control and Prevention. Discover what health professionals are seeing in the emergency room and find out what they say are valid reasons to visit the ER.

Severe symptoms, like fevers lasting 48 hours, abdominal or chest pain, and broken bones are best treated in an emergency room, says Dr. Daniel Reaven, of Northwest Community Hospital, in Arlington Heights. For other less clear-cut situations, Reaven suggests first contacting your primary physician.

Whether it’s a television drama or firsthand experience, medical center emergency rooms are a magnet for high-energy, intense situations, emotional extremes and, above all, medical treatment sometimes verging on miraculous. The ER is a place where anything and everything can happen. Dedicated doctors and nurses stand ready to help whoever comes through the doors.

According to the Centers for Disease Control and Prevention (CDC), more than 136 million people visit America’s emergency rooms annually. So highly trafficked are these vital care centers that an average 45 of every 100 people will visit the ER this year. More than 16 million are hospitalized as a result of their visit, with more than 2 million placed in critical care.

When to Seek Care

The decision to seek emergency medical treatment personally or for a family member, coworker or friend is not always clear-cut. Some fear learning that their problem is trivial, while others underestimate the seriousness of their symptoms.

Dr. Daniel Reaven, emergency medicine specialist at Northwest Community Hospital, in Arlington Heights, clarifies some of the symptoms that should help people evaluate their condition more clearly.

“Anyone who has had a fever, for more than 48 hours, that has not responded to Tylenol or ibuprofen would be a good candidate to seek medical attention,” Reaven says. “Any symptom of chest pain, shortness of breath or severe abdominal pain should definitely come to the ER. Headaches, sudden onset of weakness or numbness as well as broken bones and bad lacerations are also valid reasons to come into the ER.”

Additionally, any hint that a person may be suffering from a drug overdose is enough to warrant emergency response.

Reaven points out that emergency room staff readily treat all patients, including those who come in with respiratory complaints including colds, sinus infections, severe sore throats, ear infections and other troubling health problems.

“We are here to serve,” he adds. “But having said this, I want to point out the importance of each patient having a primary doctor.”

Primary care doctors are the pivot point for optimal care, Reaven says.

“A primary doctor has your health history on file,” he adds. “When you call his or her office with a concern, this doctor will know if you need to come into the office, go to an immediate care center or head for the ER. Not only will this ensure you receive the appropriate level of treatment, but it will also be cost-effective. We will treat every patient who comes in, but ER care is expensive compared to an office visit or immediate care.”

Until recently, there was a growing trend to use the ER for non-emergency ailments such as runny noses, sore throats, sprained ankles and other minor health issues.

“Sometimes it is difficult to determine, especially when the patient is an infant or small child,” Reaven says. “Things an adult might hesitate over are magnified in children.”

Regardless of what brings patients into Northwest Community Hospital’s ER department, each person is seen within minutes under the newly introduced Rapid Medical Evaluation (RME) program.

“We used to use a red-yellow-green triage system to assess ER patients, but now we have RME,” Reaven says. “A medical provider is stationed at the ER door and evaluation begins immediately. A work-up is done to initiate the treatment process, after which the patient is sent to have lab testing, X-rays and pain medication, if needed.”

Patients are then treated in the ER area. Those with a serious illness or injury are admitted after initial treatment.

“We rarely see patients waiting for treatment as has happened in the past, and still can happen in other hospitals,” Reaven says.

The bottom line?

“We would all rather see patients come in when there is something wrong, even if it’s not life-threatening,” he says. “If it scares a patient enough to bring him or her into the ER, then it is an emergency to us as well.”

When Every Minute Counts

One of the most powerful fears impelling people to head for the ER is the concern they are having a heart attack. Patients come into Centegra Health System’s three McHenry County hospitals with symptoms suggesting heart attack nearly every day. Dr. Daniel Campagna, medical director of emergency services over all three of Centegra’s regional treatment centers, says that, regardless of how they arrive, patients and their symptoms are taken seriously.

“Patients who come in by ambulance have already had treatment started,” Campagna says. “The paramedics have performed a 12-lead electrocardiogram (EKG) to determine if a patient has suffered a STEMI.”

ST-Segment Elevation Myocardial Infarction (STEMI) is the name cardiologists use to describe a classic heart attack. Myocardial infarction (MI) is the medical term for heart attack, which refers to the death of a portion of the heart muscle (myocardium) caused by blood flow interruption. “ST segment elevation” refers to a particular pattern seen on an EKG when a substantial part of the heart muscle is dying.

When patients with suspected acute MIs come in by ambulance, they are often sent directly to the catheterization laboratory (cath lab), where an angiogram is performed to locate the blockage. And while the patient is en route, the cath lab staff and cardiologist on call are alerted so they’re ready when the patient arrives.

“Patients who are brought in by family members or friends are immediately evaluated by our triage team,” Campagna says. “They have an EKG performed within 5 minutes of arrival and, depending on the results, the cath lab and cardiologist are alerted.”

Federal regulations mandate that MI patients receive definitive cath lab treatment within 90 minutes of arriving at the ER. At Centegra Hospital-McHenry, that time averages less than 60 minutes from door to stenting.

The two most common symptoms of MI are chest pains and difficulty breathing, but Campagna says upper back pain also is a frequent symptom.

“In the elderly, we often see nausea and vomiting occur,” he says. “And when the patient’s muscle damage is in the inferior wall at the base of the heart, they may experience abdominal pain.”

If there is any doubt that the patient has an MI, doctors conduct blood tests to look for cardiac biomarkers – proteins from heart muscle cells that have leaked out into the bloodstream because of injury to the cardiac muscle, Campagna says. Creatine kinase and troponin are the proteins measured in biomarker tests.

Most commonly, elevated cardiac biomarkers in the blood indicate that an MI is occurring. However, biomarkers also can become elevated from heart muscle damage due to other causes, such as traumatic injury.

“The next steps after an EKG, when we don’t find a STEMI but are concerned, is to attach a cardiac monitor and conduct a deeper physical examination,” he says. “Family history and metabolic tests help us evaluate the patient’s precise condition.”

Undiagnosed congestive heart failure could be just as serious as an actual MI. It’s essential to rule out life-threatening conditions of the lung, vascular system and gastrointestinal system, as well.

“Not every symptom and condition is life-threatening in itself,” Campagna says. “But diseases in the lungs and adjacent organs can adversely affect the heart and must be taken seriously.”

Once the patient has been diagnosed, the treating emergency physician decides whether the patient should be admitted for intensive treatment.

Michelle Green, Centegra Health System public relations and communications manager, stresses the importance of calling 911 when any symptoms of an MI develop.

“We strongly encourage people to call 911 for several reasons,” she says. “Evaluation and treatment begin immediately when the paramedics arrive, saving valuable time. If a patient drives or is driven to a hospital where a cath lab team is not available, precious time can be lost during the transfer to another hospital.”

Other Reasons to Visit the ER

Injuries resulting from sports, falls and vehicle accidents are more reasons why people seek treatment in an ER. Patients with orthopedic injuries come into the emergency room at Presence Saint Joseph Hospital, in Elgin, on a daily basis. Dr. Soriya Pok-Todd, emergency department medical director, says all of these types of injuries are treated, regardless of their nature.

“We see patients with sprains, minor fractures and dislocations all the time,” Pok-Todd says. “While they could be treated at urgent care clinics that have X-ray and other special equipment, we do treat them in the ER and then refer them to an orthopedic specialist.”

Care for these minor injuries can include temporary splints for sprained or fractured fingers and broken arms and legs.

“We reduce the fracture, meaning we make sure the break is properly aligned to minimize the angle of the break and to ensure there is no bone piercing the skin,” Pok-Todd says. “We then stabilize the break with a temporary splint. We don’t put a cast on breaks because of the risk of swelling around the break site for several days. Swelling can cut off blood flow to the part of the body on the other side of the cast. We use a splint that does not wrap completely around the limb, to allow for swelling.”

Once a break is set and stabilized, the patient is usually sent home with a referral to an orthopedic specialist for a cast, which can be left on the broken limb for up to eight weeks, Pok-Todd says. The same holds true for dislocations that have been realigned. Unless the patient has other mitigating conditions, the best place for them to recover and receive advanced treatment is at home.

“When patients come into the ER on their own, St. Joseph assesses them using the RME (Rapid Medical Evaluation) system,” she says. “This means they are seen within minutes and a determination is made as to how they will be treated. Usually, a nurse practitioner or physician assistant makes the decision and fast-tracks those patients with more serious injuries.”

These conditions can include joint reductions, bone splints and other compound injuries. When patients come in by ambulance because of an accident or other traumatic event, this triage method is sped up significantly.

“Paramedics have already made vital evaluations before the patient arrives at the ER,” Pok-Todd says. “In these cases, they are seen by a special provider immediately and a bed is already reserved for them.”

Trauma patients are fast-tracked to X-ray, and pain-relieving medications are started as soon as the patient arrives ­– if the paramedics haven’t already administered medication. Patients are evaluated to determine if any airway, breathing or circulation issues are present.

“Sometimes, trauma patients come in not only with orthopedic injuries but also with internal ones as well,” Pok-Todd says. “We treat life-threatening injuries first and foremost. A patient with broken bones may also have damaged internal organs, concussions or head injuries, and other critical conditions. We stabilize the orthopedic injuries but further treatment may need to wait, especially when the patient requires immediate surgery.”

Ready for Anything

The CDC reports that overall use of emergency services has increased in the past decade and, since the implementation of the Affordable Care Act, the number of people seeking ER care has risen even more quickly. The most common reason for ER visits is fever in patients ages 1 to 17, followed by superficial injuries in all age groups except infants. Further, many children and teens are treated for open wounds to the head, neck and body. For older adults, mostly age 45 and up, chest, abdominal and back pain are the most common complaints.

Having a primary physician helps patients make the decision on where to seek treatment more efficiently and cost-effectively. However, ER staff are always ready to help, regardless of what brings a person through their doors.

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