Here’s how to tell if your illness or injury requires a trip to the ER

A slip on the ice or a really bad case of the flu are definitely reasons to stay home from work, but are they reasons to seek emergency medical attention? That’s a call that only a health-care professional can answer, experts say.

Despite what popular opinion (and detractors of universal health care) would have us believe, taking a trip to the ER is rarely a waste of anyone’s time. Nor are waiting areas clogged up with paranoid people who don’t need emergency attention.

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“The people who are low acuity are not the primary cause of crowding in emergency rooms,” says Dr. Paul Hannam, chief and medical director of the Department of Emergency Medicine at Michael Garron Hospital in Toronto. “It’s well studied that people who may not need to come to the ER are not the reason it’s so busy. Because if someone who truly didn’t need to go does go to the ER, it doesn’t take very much time or many resources to treat them and send them home.”

There’s a reason, he says, why the outgoing message at your family doctor’s office or the Telehealth hotline ends with saying, if the matter is urgent, go to your nearest emergency room.

“What every patient is faced with is, ‘I have chest pain; is it a heart attack?’ And no one can answer that question unless they work in health care. We wouldn’t blame someone for coming to the ER for that.”

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When in doubt, he says, call Telehealth where you can speak to a registered nurse who will ask you the appropriate questions to help determine whether you require immediate emergency medical attention.

“The answer about whether you should go to the ER is always: it depends,” Hannam says. “If you got a bad cut on your finger, that doesn’t necessarily mean you need to go to the hospital, but if you have a chronic illness like diabetes, can’t control the bleeding or the extremity is tingling, you need to seek help.”

The same goes for taking a fall, he says: “It’s one thing to slip on a patch of ice, but it’s another if a person is walking and suddenly finds themselves on the ground because they fainted.”

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So, how can you tell if you need to go to the ER? While, as Hannam says, it depends on a number of factors, ranging from age and general health level to the nature of the illness or injury, Hoda Mankal, director of communication for the Nurse Practitioners’ Association of Ontario, broke down some general rules and questions to ask yourself to determine if you should go to the ER, stat.

Chest pain

• If the pain is located in centre of chest, and is radiating to your arms, jaw, back, neck or stomach
• If you are experiencing shortness of breath
• If you have cold sweats
• If you are also nauseous or vomiting
• If you feel lightheaded
• If you are fatigued
• If you are experiencing diaphoresis (excessive sweating)

Headache

• Do you have a sudden onset “thunderclap” headache? Does it feel like “the worst headache in your life?”
• Are you over the age of 50 with no previous history of headaches?
• Are there changes in your vision?
• Do you feel weak or have trouble with your balance?
• Is the headache increasing in severity of pain?
• Is it a headache that is subsequent to head trauma — i.e., a concussion as a result of an accident? (This is especially precarious if someone is on blood thinner medication.)

Stomach pain

• If it is sudden onset or worsening abdominal pain
• If you are vomiting blood
• If you have difficulty standing up straight due to pain and are guarding your abdomen (in other words, you can’t tolerate anyone touching your stomach)
• If you have a fever
• If you are a woman of childbearing age that has confirmed pregnancy
• If it’s testicular pain that is referred to the abdomen

Cuts

• Is it a deep cut that has gone through the tendon or do you have bone showing?
• Is it a cut sustained from a dirty object, like a rusty screw or dirty knife?
• Are you diabetic?
• Do you have hemophilia or are you taking blood thinners?

Fever

• If it’s any fever in a baby less than three months old; does the baby show a change in feeding, lethargy or signs of dehydration?
• If it’s a persistent fever that won’t decrease with use of antipyretic (Tylenol) and NSAID (Motrin)
• If you have a seizure as a result of fever

Vomiting

• Are you vomiting blood? It can look like bright red blood or it can look dark black and resemble coffee grounds
• Is it persistent vomiting? And if it’s accompanied by diarrhea, do you exhibit signs of dehydration, like poor urinary output, dry lips and mucous membranes, sunken eyes and lethargy?

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“The drive to seek care is quite dynamic. In some cases, we know that people who are low-income and can’t visit a family doctor during the workday because they can’t take the time off will go to the ER, while others do it out of fear or perceived urgency,” Hannam says. “Regardless, we always have to think of those exceptional cases where hours or minutes will make all the difference.”