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When to Go to the Emergency Room

Posted 11/6/2014

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  Yesterday I wrote about travel, and today the topic is a trip that no one ever wants to take: to the Emergency Room. One national problem with ERs is their use by people who really do not need to be there. Far too often, people who don't have regular doctors or medical connections head for the nearest ER with a problem that does not need that kind of sophisticated management. There are growing numbers of Urgent Care centers, and those are a better choice in many circumstances. We, however, are not talking about a child with a cough and fever or a persistent headache or a minor fall; we are talking about potential cancer emergencies that do belong in the ER.

  When you begin active treatment for cancer, you are always given information about the symptoms that require a call to the doctor. For people on chemotherapy, that usually means a temperature over 100.2 or sudden signs of infection/cellulitis or intractable nausea and vomiting. In virtually any circumstances (this excludes moments when you might be having a heart attack or a stroke or some other dangerous acute episode), you can call your doctor and discuss the next steps. During a workday, the suggestion might be to come in to the doctor's clinic rather than to the ER.

  This is an excellent article from NCCN about when to head right for the ER. I give you the start and then a link. It would be wise to bookmark or save this somewhere you can find it for future reference.

When to Go to the Emergency Room

All patients should have a clear understanding of when certain side effects, or escalating or uncontrollable pain,
warrant a visit to a hospital emergency room
Side effects are a common occurrence for people undergoing cancer treatment. Nausea, vomiting, fatigue, and other physical discomforts are notorious symptoms of chemotherapy and other cancer therapies. Because of the strength and toxicity required of many cancer treatments in order to kill cancer cells, most, if not all, patients expect that they will experience some unpleasant symptoms during and even after treatment. However, for this reason, many people may not know how to determine when their side effects are beyond the norm and severe enough to require special medical attention.
All patients should have a clear understanding of when certain side effects, or escalating or uncontrollable pain, warrant a visit to a hospital emergency room, or ER. Following surgery, or at the onset of treatment or the start of a new or increased dosage of a medication, you should have a discussion with your physician about possible side effects, pain, or other reactions. Make sure you have an idea of when it is important for you to contact your doctor or seek immediate attention (such as a fever of 101°F or higher). Often it's better to err on the side of caution, because sometimes symptoms are easier to treat and can be managed more effectively earlier rather than later.
If at any time during or after treatment, you experience symptoms other than what you are expecting, or if you feel much worse than you believe you should, it is imperative that you seek medical attention immediately. Barbara A. Murphy, MD, associate professor of Medicine and Director of the Cancer Supportive Care Program at Vanderbilt-Ingram Cancer Center in Nashville, says side effects are often expected complications of cancer therapy. "Prior to treatment, the health care staff will review potential side effects with patients and provide them with medications that can prevent or treat side effects if they occur." If you experience expected side effects that are controlled with medications, action may not need to be taken, she says.
However, when and if you develop uncontrolled or unexpected side effects, such as sudden pain, a rise in temperature, altered mental status, or nausea or diarrhea that cannot be controlled with medication, a call to the doctor's office is indicated. "Most cancer doctors have an answering service that is available 24 hours a day, seven days a week specifically for this purpose," Dr. Murphy adds.


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