- The Washington Times - Monday, January 1, 2007

Reston resident Roger Brown called his doctor on a Friday morning and was told to go to the emergency department.

The 75-year-old man, who was experiencing internal bleeding, drove himself and his wife, Nancy, to Georgetown University Hospital in Northwest.

“It’s a good hospital. It has a wonderful reputation,” Mr. Brown says about his choice to drive to another jurisdiction for care that is “thorough, courteous and professional.”

Mr. Brown and his doctor made the right decision, says Dr. Eric Glasser, assistant clinical chief of emergency medicine at Georgetown University Hospital.

“If you think you have internal bleeding, you should go to the emergency department,” says Dr. Glasser, a fellow of the American College of Emergency Physicians (ACEP), a national association for emergency physicians headquartered in Irving, Texas. He is also president of the D.C. chapter of ACEP.

“If your symptoms are changing rapidly or you feel like you can’t get there by yourself, you should call an ambulance,” he says.

Metro-area emergency department physicians provide advice on when patients should go to the emergency department or opt instead for the doctor’s office, an urgent-care facility or a walk-in clinic.

“If the patient feels that they could be having a life-threatening event, they should come to the emergency department and get checked out,” Dr. Glasser says. “Even if it turns out to be nothing, I tell them I’d rather they come in with their symptoms than stay at home.”

ACEP identifies several warning signs that indicate a medical emergency, such as difficulty breathing, chest or upper abdominal pain, sudden dizziness or weakness, changes in vision and difficulty speaking.

“I like to break it down more to what the patient experiences,” says Dr. Brian Keaton, ACEP president and attending physician and core faculty for the Department of Emergency Medicine at Summa Health System in Akron, Ohio. “Is it sudden? Is it new? Or is it severe? And if you have a chronic problem, has it changed from what the baseline problem was?”

ACEP’s warning signs can point to a variety of medical conditions, but the signs for a heart attack, stroke or excessive bleeding are especially important for patients to be wary of, since time is critical, Dr. Glasser says. The treatment options for a heart attack decrease after one hour and after three hours for a stroke, he says.

A heart attack, caused by a blockage to the blood supply to the heart, is indicated by chest pain or tightness, lightheadedness, shortness of breath and pain radiating to the left jaw or left arm, Dr. Glasser says.

For a stroke, a blood clot or bleeding from an erupted blood vessel blocks or decreases blood flow and can cause severe headache, change in speech or vision, slurred speech and weakness on one side of the body, he says.

“That’s what we’re there for, to access that and make sure it’s not something serious,” says Dr. Mark King, director of the emergency department at Howard County General Hospital in Columbia, Md. “If you have long-standing symptoms or minor symptoms, then you should first consult with your primary-care physician.”

A minor problem that causes mild, not acute, distress likely means a doctor visit, while sudden distressful situations may require a visit to the emergency department, says Dr. Jeff Dubin, medical director of the emergency department at Washington Hospital Center in Northwest.

“If there is a sudden distressful concern, a sudden change in your health that is concerning enough to you, you should go,” Dr. Dubin says.

A broken bone or the need for stitches also justify a visit to the emergency department, since most doctors’ offices are not equipped to handle that type of care, he says.

The doctor’s office is best for minor scrapes, abrasions and sprains, along with cold or minor flu symptoms, physical and annual exams, medication refills and chronic medical conditions, though the emergency department has had these types of complaints, Dr. Glasser says.

Emergency departments in several states and jurisdictions, including Virginia, Maryland and the District of Columbia, use the prudent layperson definition to distinguish between the need for emergency or for physician care, says Dr. Michael Washington, chairman of the emergency department at Howard University Hospital in Northwest.

The prudent layperson definition defines an emergency medical condition as any medical condition that a prudent lay person, or someone who possesses an average knowledge of health and medicine, thinks may pose an immediate threat to life or cause serious disfunction to any body organ, Dr. Washington says.

“What an individual may think is an emergency, their health plan may not think is an emergency. The rule mediates between the two,” he says.

Dr. Glasser advises patients to be aware of a few things when visiting the emergency department. He says to expect to wait, to not expect an exact diagnosis, and to realize that the most critical and sickest patients will be seen first under the hospital’s triage system — a system where a triage nurse assesses the complaint, takes vital signs and asks for medical history to prioritize the highest acuity patients.

“What is going to be important is to rule out those life-threatening problems,” Dr. Glasser says.

Patients will be seen based on the time they arrive, how busy the facility is and the significance of their complaints relative to the other patients needing care, Dr. Dubin says.

“Sometimes more people come in all at once,” he says. “It doesn’t mean we’re not going to see everybody.”

Patients can help streamline their visit and save time by taking a few steps beforehand, Dr. Glasser says. They can bring a list of their medications and supplements, identify their allergies, and provide the name of their physician and medical history, he says.

Other information that is useful is medical records, physician’s notes and discharge summaries, Dr. King says.

The medications list, which can be kept in a wallet or purse, lets medical staff know which medicines to avoid that could interact with the patient’s prescriptions and give an indication of what may be wrong with the patient, Dr. Dubin says.

Patients should not gather the information if time is critical, since the health care team will be able get the needed information in other ways, Dr. Washington says.

“If you do have time, try to get those things together,” he said.

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