Top 5 Reasons for Emergency Room Visits
Joanne Pallotta Beth Israel Deaconess Medical Center correspondent
OCTOBER 01, 2014
While no one wants to pay a visit to the emergency room, it may be the only place to get the advanced, critical care needed in the quickest amount of time. Jane DuFresne, Nurse Manager of the Emergency Department (ED) at Beth Israel Deaconess Medical Center, says these are the top five reasons people visit the ED:
1. Abdominal Pain
Pain in the abdomen is a common presentation to the Emergency Department at BIDMC. The problem could be minor or more serious, potentially life threatening in nature. Symptoms range from heartburn, nausea, vomiting, bleeding, and/or diarrhea/constipation.
Physicians and nurses will conduct a physical exam and history. Based on the assessment, further diagnostic testing, such as lab studies, ultrasound, or computed tomography (CT), may be needed.
DuFresne says a large number of these patients are either admitted to the hospital or observed in the Emergency Department for an extended period of time. The patient’s disposition is determined by diagnostic results and response to the treatment plan.
2. Chest Pain
Chest discomfort or pressure is a very concerning complaint that should not be dismissed, DuFresne says. Her advice is to contact a physician immediately; if a person is unable to reach his or her primary care physician (PCP), they should go to an emergency room for evaluation.
While in the ED, the person experiencing chest pain will receive an electrocardiogram (ECG) upon arrival to rule out the possibility of an acute cardiac event. Once that is ruled out, further assessment by a physician and nurse will occur and additional diagnostics may be ordered.
The patient’s past medical and family history influences clinicians in determining if a patient is high risk for a cardiac event. It is not uncommon for high-risk chest pain patients to be observed in the ED for six to 24 hours, DuFresne says. During this time, they receive additional diagnostics, such as repeated lab tests, ECG, and/or a stress test. Many of these patients will be discharged with recommendations to follow up with their PCP and additional outpatient testing and consults.
A fall might result in anything from a sprain or fracture to a serious head injury. While most people might hold off a visit to the ED after a fall, DuFresne points out there are symptoms that should not be ignored and require a medical evaluation.
“You should absolutely come in if you see a deformity, changes in coloring and function, or coolness in the limbs,” she says.
Delayed treatment of fractures can result in long-term complications including deformity, disability, and avascular necrosis from decreased blood supply.
A fall that results in a direct blow to the head could leave the patient with concussion. Concussive symptoms include altered mental status, nausea, vomiting, temporary amnesia and headache.
“If you are experiencing any of these symptoms, seek care immediately,” says DuFresne.
Generally, these patients are discharged as long as there is someone who can observe them overnight for complications or worsening of symptoms. Patients can experience symptoms up to one year after the initial injury.
A minor fall may result in serious injury for anyone, but this is especially true for the elderly. A large percentage of this population is prescribed medications that may result in a secondary injury, such as head bleed caused by anticoagulant therapy. The healing process with these patients may be prolonged due to age and comorbidities.
4. Shortness of Breath
There are many reasons someone might experience dyspnea, or shortness of breath. These can range from simple allergies to something complex, such as a cardiac event. As with all patients presenting to the emergency room, a rapid assessment is completed to determine the underlying cause of the symptom.
“If you have shortness of breath that you cannot explain and it is affecting your ability to function, you should seek medical attention,” advises DuFresne.
Headaches are one of the most common complaints seen in the ED at BIDMC. Most headaches are not serious; however, headaches can be an indicator of a serious medical issue. In the Emergency Department, the focus of the team is to rule out any serious conditions, treat the pain, and any related symptoms.
“Sudden onsets of headaches with associated visual changes or neurological deficits should report to an Emergency Department immediately,” says DuFresne.
Emergency Room Traffic
Even though the Emergency Department at BIDMC is a 24/7 operation, DuFresne says there are certain times of the day, week, and year that are busier than others. For instance, mornings are quieter times.
“As the day progresses, it becomes busier," DuFresne says. "People often try to manage symptoms at home, hoping they will begin to feel better. When they eventually decide to seek medical care, and their normal access to care is not available to them, that’s when they arrive in the ED.”
She says Mondays and Fridays tend to see more traffic than others, as do the days after a holiday.
“People want to spend the holiday with their family,” DuFresne points out. “They will actually push themselves beyond their limits and delay care, arriving to us much sicker.”