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FirstHealth of the Carolinas
When it’s time to go to the ED By Nina Silberstein

Some people go to a hospital for emergency care when they have a bad cold or skinned knee. Others resist going even if they have a broken bone or ruptured appendix.

So what, exactly, is an emergency, and when should you go to an emergency department?

“An emergency is any illness or injury that could cause death, disability or disfigurement if not evaluated and treated quickly,” says Ted Graham, M.D., medical director of the Emergency Department at FirstHealth Richmond Memorial Hospital. Dr. Graham is a member of Sandhills Emergency Physicians, the group of specialists who staff the emergency departments at the three FirstHealth Hospitals: Moore Regional, Richmond Memorial and Montgomery Memorial.

Often, when people are in pain or feel sick, they don’t know if whatever is causing their symptoms is really serious. For example, if you wake up in the middle of the night with abdominal pain, should you assume it’s just gas or dial 911? Dr. Graham says it’s always better to err on the side of caution.

If you have chest pain, you definitely should call your physician or go to an emergency department, says Steven Strobel, M.D., another FirstHealth emergency physician. He recalls a patient who came to Montgomery Memorial Hospital’s Emergency Department complaining of pressure and pain in his chest.

“He collapsed as I was helping him onto the bed,” Dr. Strobel says. “His heart stopped; he had no pulse and no blood pressure.”

Dr. Strobel and the Emergency Department nurses performed CPR and used a defibrillator to shock the patient’s heart back into rhythm. Less than two hours later, he underwent an angioplasty procedure at Moore Regional to open his severely clogged coronary arteries. If he hadn’t gone to the Emergency Department when he did, he probably wouldn’t have lived.

Ted Graham, M.D., examines a patient in the Emergency Department of Richmond Memorial Hospital.

A number of different conditions can cause symptoms similar to those of a heart attack. For example, acid reflux disease, which typically triggers the burning sensation we know as heartburn, also can cause deeper chest pain, says Ravi Varanasi, M.D., a gastroenterologist with Pinehurst Medical Clinic.

“Most gastrointestinal disorders and other conditions can wait to be taken care of, but heart attacks can’t,” he says. “So, if there is any doubt about what the problem is, you need to get your heart checked immediately.”

You also need emergency evaluation if you suddenly feel dizzy or have trouble walking, if your speech is slurred, or if you feel weak or numb on one side of your body. You could be having a stroke. Most strokes are caused by a clot in a blood vessel that cuts off the blood supply to part of the brain. When this happens, brain cells begin to die.

A “clot-busting” drug called t-PA can restore blood flow and limit brain damage. But t-PA must be given within the first three or four hours after the onset of a stroke. Many stroke patients do not receive treatment within that timeframe, because they don’t recognize the symptoms and seek emergency help soon enough.

There are many reasons for going to an emergency department other than symptoms of a heart attack or stroke, Dr. Graham says. These include choking, fainting, poisoning, difficulty breathing, uncontrolled bleeding, animal bites, sudden vision problems, and thoughts of harming yourself or someone else.

If you have a serious chronic condition such as diabetes, emphysema or high blood pressure, you could find yourself in the Emergency Department if you fail to take your medications or don’t follow your doctor’s advice about taking care of yourself.

Men and medical care
Of course, not everyone has a regular doctor. Men are less likely than women to have a primary care physician or to go to their physician when they are sick, so it isn’t surprising that men also avoid going to the Emergency Department for as long as they can.

“Men still see themselves as invincible and feel that seeking care is a sign of weakness,” Dr. Graham says.

Some people, especially men, even put off seeking treatment for painful injuries.

“It isn’t uncommon for them to wait overnight before coming in with broken bones or deep cuts,” Dr. Graham says. “Often, they will only come in when they find they can’t work because of the pain or because the bleeding won’t stop.”

While medical emergencies such as heart attacks and strokes are more common in people who are middle aged and older, “certain traumatic injuries requiring emergency care tend to occur more frequently in younger men,” says Chad Listrom, M.D., another FirstHealth emergency physician.

Examples include highway accidents, knife and gunshot wounds, power tool mishaps, and falls off of roofs or ladders—especially, for some reason, when hanging Christmas lights. Injuries requiring emergency care are common among backyard athletes, also known as “weekend warriors.” They sometimes break bones, sprain ankles and suffer concussions.

Dr. Graham recalls treating a teenage boy who had broken his shin in a soccer game. “It was dangling and really hurt,” Dr. Graham says. “He didn’t come in for eight hours, because he didn’t want to get a shot.”

The "weekend warrior"

You know the type—the inactive guy who doesn’t get regular exercise during the week, but goes all out on the weekend. He’s guilty of trying to push the out-of-condition, over-30 body too far and too fast.

And he’s usually very competitive.

These “weekend warriors” are prone to such injuries as strains, sprains, stress fractures, shin splints, hamstring pulls, low-back pain, heel pain, blood blisters, broken noses, tendonitis, and dislocated shoulders, hips and fingers—not to mention bruises, abrasions, lacerations and concussions.

Orthopaedists know them well.

“A friend of mine was playing tennis and tore his cruciate ligament, messing up his knee pretty badly,” says Glen Subin, M.D., a Pinehurst orthopaedist with a special interest in sports medicine.

“People fatigue and end up injuring themselves, especially if they are less conditioned,” he says. “Usually, we see them get injured in the middle to late part of their workout or at the end of the game.”

Ted Graham, M.D., of Sandhills Emergency Physicians says the weekend injuries he treats include lots of injuries related to the back, ankle, hand, wrist and shoulder, as well as lacerations. Many injuries occur during various types of recreational activities, especially when the participant isn’t being as careful as he should be and often around recreational vehicles.

“Weekends are common times for riding ATVs (all-terrain vehicles),” Dr. Graham says. “ATV accidents often result in very serious injuries. People incorrectly feel safe in them and, therefore, do not wear helmets and drive recklessly.”

Glen Subin, M.D.

Dr. Subin sees lots of running injuries, too. Ankle sprains, fractures, tendonitis, meniscal tears and knee injuries are common. “Outside, you’ve got a lot of (surface) imperfections and when you’re running, you’re looking straight ahead and not down,” he says.

He has recently seen several men who have ruptured a bicep tendon while doing activities involving heavy lifting. “I think it has to do with stretching and conditioning,” he says. “People just go out and start ‘doing’ but are prone to injury because their muscles are not warmed up.”

To treat the weekend warrior’s woes, Dr. Subin recommends the RICE regimen (rest, ice, compression, elevation). Rest helps prevent further injury and allows healing. Ice stops swelling, constricts injured blood vessels and limits the bleeding in the injured area. Compression further limits swelling and supports the injured joint, and elevation uses gravity to reduce swelling in the injured area by reducing blood flow.

There are several things guys (or gals) can do to reduce their chance of injury:

  • See a doctor for a physical before becoming active.
  • Commit to some form of regular activity to sustain a level of fitness. In other words, train for the sport with pre-season exercise.
  • Make sure equipment is as safe as possible and is appropriate for the sport.
  • Exercise with a teammate, referee or a spectator who knows first aid.
  • Warm up and stretch.
  • Drink plenty of water during and after the activity.

If you feel pain, discomfort or fatigue, stop. Don’t overdo it and remove yourself from the game or activity. And give yourself a chance to cool down afterward.

When performing odd jobs around the house, make sure that common hazards are eliminated, wear appropriate protective clothing and follow safety instructions. Wear a brace or support to alleviate stress on the lower back if heavy lifting or repetitive motion is part of the task.

Most importantly, don’t let your ego make you do things you’ll regret the next day. The best thing to do is avoid overdoing it in the first place by building up your endurance and strength over time.

And, by all means, see your doctor to help diagnose your injury if:

  • Things get worse or don’t improve
  • You have severe pain or it radiates to another area of the body
  • You can cause pain by pressing on a specific area, but the pain is not produced by pressing on the same point on the other side of the body
  • You have any injury to a joint that produces significant swelling
  • You cannot move the injured part
  • There is persistent numbness, tingling or weakness in the injured area
  • The affected area seems to be infected