By Deborah Jeanne Sergeant
If you or your child need healthcare, how do you determine the urgency of the need? Should you wait for a primary care provider appointment, rush to the local urgent care center or call an ambulance for an emergency room visit?
Local experts offered a few guidelines:
— From Matt Cambareri, family physician, West Taft Family Care, Liverpool:
• “The ER is for emergencies: a child that’s short of breath, [showing] symptoms of dehydration like they’re not making tears or an infant with sunken eyes or a sunken fontanel— the ‘soft spot’ — or a child that’s lethargic, not interested in playing or eating or ‘off.’
• “ The ER is for broken bones or a concern that someone has broken a bone. One of the classic things is if it’s a lower extremity and they can’t bear weight. You’re better off going to the ER because they can get an orthopedic consult. If someone has an injury and there’s a lot of swelling and pain and they can still walk on it or move it, it might be a good thing for an urgent care. They can do X-rays on the spot and simple casting of something that’s a small fracture.
• “If someone has low back pain for a few months and it’s a bad flare-up, start with a talk with their primary care. Most low back pain doesn’t need to be dealt with in an ER unless there’s severe loss of sensation, bowel/bladder function or inability to walk.
• “Urgent care is when you can’t get into your primary.
• “I reassure my patients that if they’re still eating, drinking, peeing, pooping and playing, they’ll probably be OK, even if there’s a fever. As long as they’re drinking and not lethargic, we can see them tomorrow. Kids will have fevers, snotty noses and throw up. Those who are wheezing and asthmatic, that can be an emergency.
• “If they’re under 1 month and have a fever, that’s an emergency. They have no immune system except borrowed from Mom through breast milk and what Mom passed on through the blood. Meningitis in a less-than-a-month old can go south in a hurry. Dehydration is a major issue to these kids. We take it super serious in the setting of a newborn.”
— From Physician Wayne Chou, St. Joseph’s Health Urgent Care:
• “The role of the urgent care is to see acute care issues that can be resolved relatively quickly. Urgent cares best deal with complaints such as a cut, injury, fall, a urinary tract infection, a recent cold or sinus infection, a mild upset stomach, or a sudden exacerbation of a chronic condition such as worsening asthma.
• “We often see patients with the common cough and cold. Depending on the urgent care and their capabilities, urgent cares can take care of some more problematic issues such as pneumonias and influenza cases. At urgent cares where there are more testing modalities, such as St. Joseph’s Health Urgent Care, more issues can be evaluated and treated such as some abdominal pains, nausea and diarrhea, and kidney stones.
• “If people are experiencing symptoms that may be consistent with heart attack or stroke, such as chest pains, numbness or fainting, they should always go to the emergency room. Also, if a patient has a chronic complaint that has been going on for a long time, the urgent care is not the best place to be evaluated.
• “During flu season, we recommend anybody who has coughing, congestion, high fevers and body aches to be evaluated by their physician or at urgent care within 48 hours of the symptoms starting. It’s best if anti-flu medications are administered within 48 hours of symptoms starting, otherwise the benefits do not outweigh the possible risks of side effects.”
— From Tyler Greenfield, doctor of osteopathic medicine, medical director of pediatric emergency department, Upstate University Hospital:
• “There is great value in maintaining a good relationship and having open communication with your child’s primary care physician. Utilize your child’s primary care physician on call or triage nurse to help you decide whether it can wait.
• “Have your child evaluated immediately when your child is having difficulty breathing.
• “Is your child able to stay well hydrated? Is your child not drinking and urinating well? Sick children tend to eat less but are they still drinking and urinating multiple times in a day.
• “Is your child lethargic or difficult to arouse?
• “If there’s a fever, call your child’s primary care physician to discuss the symptoms, behavior and length of fever. Your child’s primary care doctor or triage nurse can help ensure you know the proper weight based doses of acetaminophen and ibuprofen. They can help you decide if an ED or urgent care evaluation is needed immediately.
• “If your child is getting worse instead of gradually getting better after the onset of viral symptoms and/or fever, you may need to go to the ED or urgent care, but call to discuss with your primary.
• “For broken bones with obvious deformities, go to pediatric ER instead of urgent care, as the broken bone may need to be reduced (set) under sedation.
• “When there is acute worsening, check with your child’s doctor, primary or sub-specialist to help determine if you should be evaluated in the ED or urgent care. Your doctor often calls us in the ED to give us a heads up since they are aware of the course and what they may be concerned about today requiring an urgent evaluation.
• “In the ED or urgent care, your child will be evaluated by the emergency department or urgent care team, not the pediatric subspecialist. Your child’s primary care doctor is your best initial advocate to place a referral and contact the subspecialist. In the ED and when a child is admitted, we involve the subspecialists for their opinion and help with acute or worsening problems.
• “Your child should be promptly evaluated in the ED if there are any concerning symptoms with head injury like loss of consciousness, mental status changes, severe headache, vomiting, gait changes, vision changes, neck or spine pain.
• “New onset or acutely worsening abdominal pain should be evaluated in the ED.”