Search for tag: "emergencies"

Interviewer: It's time for "ER or Not." That's where I come up with the scenario, give it to Dr. Troy Madsen. You get to play along at home, decide whether or not it's something you'd go to the ER or not for, and Dr. Madsen will give us the definitive answer.

So today, it's more of a general "ER or Not." Like the ABCs of emergencies, how can I decide if something that's happened to me is a reason to go to the ER or not? Do you have some guidelines for us?

Dr. Madsen: Yes, Scot. You know, this is a great time to think about it because, like you said, we really need to think about these resources in the ER and leaving these for the people who really need them right now. So a good rule of thumb is to think ABC. And we'll say ABCD. We're going to add a D as well here. So A is airway, B is breathing, C is circulation, D is disability. So if you're having issues with any of these things, you need to go to the ER.

So A would be airway, your airway is blocked. You're just not getting air in. B is breathing. I'm feeling short of breath. I just can't get a deep breath. You know, I feel like my oxygen levels are low. C is circulation. So that would be your blood pressure. My blood pressure is low, or maybe it's just really, really high and I'm having other symptoms with that. Or I feel like I'm having a heart attack, something that's affecting my body's circulation. Or certainly, if you're bleeding, you know, that's going to be losing blood and affect your circulation. Or D is disability. That would be like a stroke, like I'm disabled. You know, suddenly I can't use my left hand or my face is drooping. So those are absolutely reasons to go to the ER.

But if you don't have those things, there are lots of other resources you can use right now. And I think telemedicine is a great resource right now to call in and talk to someone on the phone, talk to a physician or a health care provider, say, "These are my symptoms." You know, "I'm having this abdominal pain. This is where it hurts. What do you think I should do?" They may say, "Ah, give it 12 hours, see where you are." Or they may say, "Go to the ER." So great time to use other resources. At times, go to the urgent care. I do know urgent cares have been really busy with lots of people with coughs and respiratory symptoms as well. But try to do something besides going to the ER and only go to the ER if you are having those things. Otherwise, start somewhere else first. They'll direct you to the ER if that's where you need to be.

Interviewer: It's an end-of-the-world scenario. What medical professional would you want on your team? We'll examine that next on The Scope.

Announcer: This is "From the Frontlines," with emergency room physician, Doctor Troy Madsen, on The Scope.

Interviewer: All right. I'm going be the first to admit that this episode probably doesn't necessarily have any useful health advice in it, but it's more of a fun podcast to do since Halloween is coming up. And I was wondering in the event of an apocalyptic situation, whether it's zombies, robots, or aliens, if we found ourselves in an end-of-the-world sort of scenario, what kind of medical professional would you really want to have on your team? And I would think that perhaps an emergency room physician might be a good one to have.

We're with Dr. Troy Madsen, who happens to be an emergency room physician at University of Utah Health Care. So who should I have? I mean, I've heard some different kind of arguments. One person said an OB/Gyn because they have the basic medical experience and also can deliver babies. I've heard EMTs because they have that kind of in-the-crisis, sort of being able to stop the bleeding sort of a situation. Or an emergency room doctor. What do you think?

Dr. Madsen: Well, here, I've got to be careful because I'm clearly biased. I mean, there's no question about it. And I know you know what you think I'm going to say and I'm not going to going it. I'm not going to say, "ER doctor." Although I think an ER doctor would be great in that scenario because we are trained in all different fields. I'm going to say a family practitioner because they can deal with the emergencies. They've had some training during their residency in dealing with emergencies. And I'm not only going to say a family practitioner. I'm going to say a rural family practitioner.

Interviewer: Get very specific here.

Dr. Madsen: Someone who works in a rural area who does minor surgeries, who does OB, they deliver babies, they do that sort of care, they deal with emergencies, they take emergency call, they do pediatrics. Because sometimes in family practice, people may become more specialized to where they're just doing clinic stuff but this is the one I want. I want a rural family practitioner in that scenario not only because of their training but because they're experienced to handle all these sorts of different things. I think they'd be a great person to have in a zombie apocalypse to take care of whatever ails you.

Interviewer: I guess I didn't consider that because we worked at a large academic medical center where, like you said, people really do specialize.

Dr. Madsen: We do.

Interviewer: And they still have to go to medical school, but they've spent the last 20 years of their life dealing with one very specific thing and probably could get the job done. But a rural practitioner, they don't have backup.

Dr. Madsen: They don't.

Interviewer: They don't have a specialist.

Dr. Madsen: They don't. If they have to get backup, they have to send them on a flight for two or three hours or they have to get them in an ambulance. So they know how to deal with this stuff. And I'm a little biased because I grew up in a small town of fewer than 10,000 people and I heard the stories there from some of these old coal camp doctors in the coal mining towns. And these guys were basically the kind of guy you'd want in the zombie apocalypse.

They would tell stories about miners coming in after head injuries and pieces of their brain sticking out. They couldn't transport these guys. They would just cut off part of their brain and stick the skull back on. And the guys were okay. They survived. They would deliver babies on people's living room tables. So these kinds of old school cowboy types, family practice types in rural areas that we certainly still have out there in a lot of these very rural communities, that's what I want in a zombie apocalypse. They . . .

Interviewer: That's who you want on your team.

Dr. Madsen: That's what I want on my team.

Interviewer: What about a vet, a veterinarian? There are sometimes these shows that have these scenarios where like, "I'm a vet." But they manage to get the job done.

Dr. Madsen: Yeah, I guess if you want to be euthanized or get immunized, you could get a vet. I'm just kidding. No. I think . . . yeah, I mean, it's funny because I once knew a vet, a woman who was in vet school and she said that . . . she made the argument that vets should be able to also care for humans because they care for all other species. Maybe there's some truth to that. I don't know. I mean, they do have a very wide skill set. Quite honestly, vet school is harder to get into than medical school. These are very sharp people.

Interviewer: And the basics are the basics, right? If something is bleeding, you stop the bleeding the same way, right?

Dr. Madsen: Yeah.

Interviewer: If something is giving birth, that kind of all gives birth in the same way, right?

Dr. Madsen: Exactly. I mean, I'm not going to go on record to say I necessarily want a vet over a family practitioner in a zombie apocalypse, but there's something to be said for . . . they have a very wide skill set, they may deal with all kinds of species.

Interviewer: All right. Let's hope that this scenario never comes true.

Dr. Madsen: Let's hope not.

Interviewer: No robots rising.

Dr. Madsen: Yeah, exactly.

Announcer: Thescoperadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at thescoperadio.com.

Dr. Miller: It's the weekend and your primary care doctor is not available. What is best for you, emergency care or urgent care? We're going to talk about that next on Scope Radio.

Hi, I'm here with Dr. Robert Stephen and he is an emergency room physician here at the University of Utah, also a member of the Department of Surgery. Robert, what do you think about that? Is there a difference between the care one gets at urgent care and emergency care rooms?

Dr. Stephen: There's not a difference in the approach to the care per se. What's different is the capabilities of each one. The emergency room is by definition capable of dealing with all manner of emergencies, be they mild and merely painful to life-threatening, whereas an urgent care is much more structured to deal with what we call lower-acuity or more minor complaints which nonetheless need to be addressed, such as sore throats, lacerations, maybe sprains, simple fractures, things like that.

Dr. Miller: So would you say if someone has a lower-urgency problem, as the examples you just mentioned, it might be better served at an urgent care center?

Dr. Stephen: I don't know if they're better served, but they may be able to be seen and treated and evaluated appropriately and discharged more quickly than a large ER that is quite busy dealing with other critically ill patients.

Dr. Miller: Now, urgent cares are not going to see very severe types of illness. Is that correct?

Dr. Stephen: Generally, no, but of course, patients don't know sometimes how sick they are, and so urgent cares certainly do get patients being brought in by family members who tend to be quite ill, and if that's the case they evaluate them and then transfer them to a higher level of care, which would be an emergency room.

Dr. Miller: Let's say you're at home, and you're watching TV and all of a sudden you have crushing chest pain. Should you go to an urgent care center or should you go to an emergency care center, or should you just call and ambulance and let them decide?

Dr. Stephen: I think if you're having truly crushing chest pain you should probably call an ambulance and go to an emergency room. Chest pain is not a complaint to be trivialized by any stretch of the imagination, and probably the better part of valor is to go to an emergency room if you're having significant chest pain.

Dr. Miller: Now very likely if you're in an auto accident and have significant trauma, they're going to take you to an emergency room, not an urgent care center.

Dr. Stephen: Correct.

Dr. Miller: But what other types of illness might you think you should call an ambulance for, and then they can decide where you need to go, or maybe ambulances just take people to the emergency room?

Dr. Stephen: Ambulances generally take people to emergency rooms, but what you call an ambulance for is honestly based on the patient's perception of their illness. If you're having something that is severely painful, or if someone is, you notice, severely confused, if they appear to be ill, if they've obviously broken something in a fall, then you should call an ambulance to have them help assist you and determine how ill you are, and then they will take you to the appropriate level of care.

Dr. Miller: Now urgent care centers, do they do the same sort of triage that emergency rooms do to decide how severe your problem is before they take you back?

Dr. Stephen: They do an initial screening questionnaire to see if you're appropriate to be cared for there, and you're usually seen by the doctor or the treating physician or the treating physician extender, depending on who's manning it, and they will make the decision on whether you're appropriate to be treated there or sent to a higher level.

Dr. Miller: Dr. Stephen, one final thing, I'd like to talk about the expense of either the urgent care center or the emergency department. Is one cheaper than the other? Is that a consideration?

Dr. Stephen: It is. Urgent cares generally tend to be cheaper than emergency departments, so that is something that some people may need to take into consideration although, again, an emergency department will see anyone at any time without regard to their ability to pay.

Dr. Miller: And urgent care centers, they tend to be free-standing, that is, not associated with a hospital, many times?

Dr. Stephen: Many times, yes. There are models where there are some associated with a hospital or they preferentially refer people to places, but generally free-standing.

Dr. Miller: Now, it's interesting, we were talking before this show about our emergency room, and it sounds to me like you've developed an urgent care center within the emergency room here. Could you talk to us about that a little bit?

Dr. Stephen: Yes, recently we established an urgent care that is actually inside the hospital itself, and is open from roughly, I think, 8:00 a.m. or 9:00 a.m. to the evening, sometime about 8:00 p.m., and again it's supposed to see more of the lower-acuity complaints, and people can request to be seen in the urgent care when they present to the emergency department.

updated: February 10, 2021
originally published: November 3, 2015