Search for tag: "emergency"

"Should I call the on-call pediatrician?" It's a question you've probably asked yourself when you have a question for your child's doctor and the clinic is closed. I'll help you figure out when it's appropriate to call and when a question can wait until the next office day.

As a pediatrician, we all take call, meaning that we rotate with our colleagues when we answer after-hours phone calls from concerned parents.

Usually, the questions parents have are very appropriate. Sometimes parents are just looking for reassurance that they're doing the right supportive care for their little one. Sometimes they're wanting reassurance that taking their child to urgent care or the emergency room is the right decision and that they're not overreacting. And sometimes they just want to know how much fever reducer to give.

One thing I don't think most parents realize is that the job of the on-call pediatrician is to help determine if their child needs to be seen urgently or not.

We cannot diagnose anything over the phone. Parents will often tell me that they know their child has an ear infection, or strep throat, or a urinary tract infection. I can't tell if your child has any of those over the phone, so they need to be seen.

We absolutely cannot call in medications like controlled substances. We cannot call in medications in general, because if your child needs an urgent medication, they should be seen.

If they need a refill of a long-time medication, that's better to be addressed by your child's pediatrician specifically during office hours. Questions that are not urgent should wait until the clinic is open.

I have one colleague who answers her calls, "Hello, this is the on-call doctor. What is your emergency?" One reason for this is we've gotten questions like, "I'm in the baby food aisle at the store. What food should I get my 6-month-old?" or, "My toddler won't take a nap. What can I do to force them to take one?" or, "How old does my daughter need to be to get her ears pierced?" These are all questions I've gotten.

One thing I've noticed in my years of taking call are that parents often think I'm sitting in the clinic just waiting for their calls. More than once, I've been asked if they can just come in and see me or if I can meet them at the emergency room.

When you call the on-call pediatrician, we are at home with our families. We are not in the office. I've answered phone calls from soccer games, while doing landscaping, when I'm doing hospital rounds in the newborn nursery, when out to eat, and of course, from my bed in the middle of the night.

As pediatricians, we want to be there for you when you have concerns. Kids don't come with instruction manuals, and often things happen when the office is closed. If you have an urgent concern, you are always welcome to call and we will give you the best advice we can. If your concern is not urgent, it will be better handled by your pediatrician during office hours.

Your pediatrician knows your child and your family. They can address non-urgent concerns better than one of us who has never met your child before.

Interviewer: When should you consider University of Utah Health's Orthopaedic Injury Clinic over perhaps a visit to the ER or urgent care, or is it something you can handle on your own? That's what we want to find out today.

Dr. Julia Rawlings is a primary care sports medicine and also practices pediatric emergency medicine, but it's that sports medicine doctor that we really want to talk to today. So the first thing I want to find out is what are some of the common orthopedic injuries a person should consider using the Orthopaedic Clinic versus an ER or urgent care?

Dr. Rawlings: The Orthopaedic Injury Clinic is a great place to go if you have an acute injury, meaning that you have had an injury that you've sustained recently. We're actually willing to see people that have had an injury anytime in the last three months, but preferably not something that's chronic and going on. We'd rather you go ahead and make an appointment with a regular physician during regular hours, although it can be at the Orthopaedic Center.

Specifically, things that are good for the Injury Clinic. So we see a lot of injuries from the ski slopes. We see people that have been playing different sports, or running, biking. We see some football injuries. Anything that's kind of acute. Anything that could go to an urgent care can go to the Orthopaedic Injury Clinic if it's a musculoskeletal injury.

A couple of things we don't see at the Injury Clinic. We don't do stitches there. So if you're bleeding and you think you need stitches, an urgent care or the emergency department would be more appropriate. Also, if your bone is pretty crooked, it's probably a better idea to go to the emergency room. We can do some local numbing medicine to set some easy broken bones, fingers, and things like that, but larger fractures would need to be seen in the Emergency Department for sedation.

Interviewer: And what kind of diagnostic tools do you have there that kind of makes you the choice for some of these as opposed to perhaps an emergency room or an urgent care?

Dr. Rawlings: Yeah. So the Injury Clinic is fantastic because we have access to x-ray on-site, and we can see those images back as soon as they are done. And depending on the time of the day, we actually can often get the reads back from a musculoskeletal radiologist within a few hours. Sometimes those reads don't come back until the next day. We don't have the capability to do CT scans at the Injury Clinic. We do have access to scheduling MRIs in the building, but that's not done the same time as the visit.

So one great thing about the Injury Clinic is you get kind of a full package. So you get your x-rays. You could get an MRI set up. We have all of the braces and everything that you would need, crutches, things like that. And then, we can get you set up with a specialist, whether that's a sports medicine surgeon, foot and ankle surgeon, or one of our non-operative primary care sports medicine physicians. We will actually make that appointment for you while you're there for follow-up.

Interviewer: So the clinic, it sounds like a better option than perhaps making an appointment. It can be difficult to get in sometimes with an orthopedic doctor at times. So this clinic, it's primarily walk-in, is that how it works, or do you have to make an appointment?

Dr. Rawlings: It is walk-in. It's a little bit tricky right now with coronavirus going on, but, typically, it is walk-in. They are switching to appointments during this period of time, but that's going to be very temporary. Generally, it is walk-in, first come, first served.

Interviewer: How can a person decide if an injury is something that they can treat at home or they can just try to see if it's going to get better versus coming into the clinic or seeing a professional?

Dr. Rawlings: Yeah. So we're always happy to check anything out if you're not sure. A couple of tips that just come to my mind. One is if you have an injury that's bad enough you can't really walk on it or bear weight on it, that's something that should be seen, probably get an x-ray, make sure you haven't broken a bone. Or if you really can't move your shoulder or can't move your arm in some way. If you twist your ankle, and you're walking on it okay, and it gets a little bit swollen, that's something that you could probably wait on at home and see how you do. But, yeah, if you have a hard time moving a body part, that's a good time to go in.

Interviewer: All right. Are there some injuries that really you do want to have looked at, otherwise it could affect you and your mobility in the future?

Dr. Rawlings: Yeah. So there are definitely, particularly injuries that involve the joints. We often like to get a sooner look at what's going on rather than a later look, just because things can happen down the road that can lead to arthritis if they're not treated early. That being said, a lot of musculoskeletal injuries aren't emergencies. Meaning, even if you get something like a torn ACL, which is considered a pretty big injury in the sports world, if you're diagnosed several days after that happens, in general, that's okay. It's not something that absolutely needs to go to the emergency department or into the Injury Clinic even the same day you have it. You'd really be okay to get yourself a pair of crutches from the garage and come in a couple of days later.

Interviewer: For the particularly injury-prone that might have some crutches?

Dr. Rawlings: Exactly. There are a lot of people with crutches in their garage from siblings, so.

Interviewer: Any final thoughts that you have when it comes to the walk-in Orthopaedic Clinic? It's such a great resource. I was able to utilize it. I had a shoulder injury. I'm not even going to go into how that happened because it was not cool, it was not athletic. But it was great because I could go in, they were able to look at it, make sure that I didn't, you know, do any permanent damage, which I didn't, and then, you know, gave me a reference to go to a physical therapist to do some exercises to rehabilitate it, so.

Dr. Rawlings: I think it's a fantastic clinic. I mean, it's staffed by people that are trained in musculoskeletal medicine, so we have a little bit of an advantage over lots of the urgent cares that are more kind of general medicine, that we treat a lot of musculoskeletal injuries. We can get you set up with physical therapy pretty easily. And one or two days of the week, we actually have a physical therapist with us in-clinic. So if your injury is appropriate for that, we can even get you started on physical therapy the night that you come in. So I think it's a fantastic resource.

Dr. Madsen: E-scooters and the emergency room, are more people going as a result? We'll find out next on The Scope.

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

Interviewer: Dr. Troy Madsen is an emergency room physician at University of Utah Health. And in Salt Lake City and a lot of communities, you'll see these e-scooters now. I bet you there's more people going to the ER, because sometimes it looks like maybe the people aren't riding them as safely as they should. Wanted to find out for sure though. Are you seeing more injuries as a result of e-scooters? What's going on in the ER here in Salt Lake?

Dr. Madsen: So in our Emergency Department, we are absolutely seeing more injuries related to e-scooters. I would say now we're seeing an injury related to scooters at least once every other day if not every day in the ER.

We looked at our numbers. We pulled all the records from our Emergency Department from this last summer, and we compared it to the summer before, because e-scooters have become very popular in Salt Lake City this year with a couple of rental companies coming in, and our number of e-scooter related injuries has significantly gone up.

Interviewer: Is it the people that are riding them that are getting hurt, or is it people that are walking and getting hit by somebody that's riding an e-scooter?

Dr. Madsen: You know, interestingly, I didn't see any cases of anyone who reported getting hit who came to the ER.

Interviewer: Hmm.

Dr. Madsen: I thought we would.

Interviewer: Yeah, I would too.

Dr. Madsen: But every one of these injuries we saw this year were people who were getting hurt riding the scooter. Most of these were orthopedic injuries, people injuring their arms, their legs. I suspect what's happening is people are running into trouble on the scooter. Maybe they hit a rock or a curb. They jump off. They're going 15 miles an hour. They try and stop themselves, but you just cannot run fast enough to keep up at that speed, so you're going to fall. And these were broken ankles, dislocated ankles, dislocated/broken wrists, elbows, shoulders, all sorts of orthopedic injuries. Some of these were very serious, where they had to go to the operating room.

We even saw some very serious head injuries as well. Interestingly, when people were asked, "Were you wearing a helmet," I didn't see any cases where anyone said yes. And several people said they were intoxicated while they were on the scooter.

Interviewer: Yeah. That's what I was wondering too. So how many of the accidents are actually intoxicated related versus just somebody who maybe was riding faster than their ability? Because these are new, right?

Dr. Madsen: Yes.

Interviewer: And they do go fast. It would be easy to outride your skill level at this point.

Dr. Madsen: Oh, it absolutely would. So of these, I would say about 20% said they were intoxicated.

Interviewer: Okay.

Dr. Madsen: So a decent number, but, you know, not the majority.

Interviewer: Yeah.

Dr. Madsen: But you're exactly right. I think of someone like myself, because most of these injuries were people between the ages of 20 and 50. And for someone like myself, I haven't personally been on a scooter in probably 20 years, and it didn't have a motor on it. So you figure I'm just going to jump on the scooter. It can go 15 miles an hour. You can imagine how you could run into trouble, try and swerve around someone or hit a curb or a rock, and you could run into trouble pretty quickly at that speed.

Interviewer: Yeah. So it sounds like that the solution maybe to this is slow down a little bit. It is good to know that it's not people getting hit, because that would be my fear as a pedestrian.

Dr. Madsen: Exactly.

Interviewer: I would, yeah. So if you're riding the scooter, slow it down. Make sure you're not riding above your skill level, and then also look out. Realize you've got, you know, there's other people there.

Dr. Madsen: Yeah. That's exactly right. My recommendation is take a few minutes just to get comfortable with the scooter. Practice turning on it, getting on and off. These things go 15 ...

Interviewer: Braking.

Dr. Madsen: Braking. Yeah, exactly. I mean they go 15 miles an hour. That's as fast as you ride on a bike.

Interviewer: Yeah.

Dr. Madsen: And wear a helmet.

Interviewer: Yeah.

Dr. Madsen: That's the other thing too. If this is part of your daily commute, you ride tracks, you catch a scooter, you go to work a mile away, bring a helmet in your backpack. Put the helmet on. It can make a big difference if you do fall off and hit your head. You'd wear a helmet on a bike. You should wear one on a scooter as well.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Announcer: The Health Minute, produced by University of Utah Health.

Interviewer: Broken blood vessel in the eye. Dr. Troy Madsen, ER or not?

Dr. Madsen: Well, a broken blood vessel in the eye is one of those things that's just absolutely obvious to everyone you see. Everyone is going to ask you about it, say, "What happened to your eye?" It's essentially just a bruise on the eye. If it happened on your hand and you had a bruise there, no one would ask about it, but the blood vessels in the eye are so small that, sometimes, maybe while you're sleeping, you just turn wrong and bump something, and it causes a little bruise there. You don't need to go to the ER for it.

Now, if you've had significant trauma to the eye, you've been hit in the eye, if you notice that there's blood behind the cornea, so in front of the colored part of your eye, that's much more concerning. But if you just wake up one day, you've got some red on your eye, it's going to heal up after a few days. No need to rush to the ER.

Announcer: To find out more about this and other health and wellness topics, visit thescoperadio.com.

Announcer: Is it bad enough to go to the emergency room, or isn't it? You're listening to ER or Not, on the scope.

Interviewer: All right. Play along if you will. ER or Not with Dr. Troy Madsen from University of Utah Health. Today's situation is you got sprayed with pepper spray, so you'd got some pepper spray in the eyes, and we're just going to go ahead and pretend that it was an accident and you weren't some sort of an assailant.

Dr. Madsen: That was my first question. How did you get pepper spray in your eyes?

Interviewer: It was an accident, either it went off or you were playing with . . . I don't know, all right?

Dr. Madsen: We won't ask questions. We won't judge.

Interviewer: Pepper spray in the eyes, ER or not?

Dr. Madsen: Probably not, because anything we do in the ER you can probably do at home. Just the question is, are you going to be able to tolerate it and be able to do this? So, like you mentioned, the big concern is going to be the eyes. It can get in your face, can get on your hands. It's going to irritate it, cause it to get red and painful.

Interviewer: Oh, even beyond the eyes, it's going to be painful and annoying?

Dr. Madsen: Absolutely. It will be. But the big issue is going to be the eyes. So there's a little saying I've heard some people say, "The secret to pollution is dilution." And if you've got pollution in your eyes like pepper spray, you just have got to wash it out.

Interviewer: Or anything else.

Dr. Madsen: Anything else. The secret is dilution. You've just got to dilute it, so that's the key. So what we would do in the ER if you came in, we would try and wash your eyes out as well as possible. And we have got different tools we can use to do that. One of them, actually, we put numbing drops in the eye and put what looks like a really thick contact lens and then we hang a bottle of normal saline, just as normal sort of fluid that we can run in there, and it just washes it all out. It just sits there and washes it.

As you can probably do something very similar at home if you can get your face under the sink or something and just let water run in it. If you let it sit there for 5 to 10 minutes and you can tolerate that with lukewarm water, you're probably going to be okay and avoid coming to the ER.

Interviewer: And same with the skin? It will irritate the skin, but just rinse it off with water and there shouldn't be any other issues, really.

Dr. Madsen: There shouldn't be unless you were to have some sort of weird allergic reaction to it or something, which would be kind of a different scenario. But if it were to happen to me, you know, personally, I would get in the shower in lukewarm water, trying to run it in, trying to get my eyes up under the shower to wash it off kind of at angle as well as I could. And that's really the best thing you can do. But if you're just not going to be able to do that, you've got to get that irrigated out of there and dilute it, and we can certainly do that in the ER.

Announcer: Want The Scope delivered straight to your inbox? Enter your email address at thescoperadio.com and click "Sign Me Up" for updates of our latest episodes. The Scope Radio is a production of University of Utah Health Sciences.

Interviewer: Today, another edition of ER or Not, with Dr. Troy Madsen. You swallowed a chicken bone. Emergency room or Not.

Dr. Madsen: So you probably don't need to go to the ER if you swallow a chicken bone. So if you happen to swallow a chicken bone, you're probably going to be fine. The things you worry about swallowing are things that are really sharp or things that are really long. If they're sharp, they can puncture the intestines as they're working their way down. If they're really long, they may not even make it past the stomach.

You got to figure most chicken bones you swallow are probably going to be splinters off a chicken bone. It's probably going to pass with no problem. But if somehow you happen to swallow a chicken bone that's longer than say three inches or a really big sharp piece, that's probably a reason to go to the ER and get a specialist there to remove it from your stomach.

updated: July 8, 2021
originally published: October 6, 2017

Interviewer: It's another edition of "ER or Not" with Dr. Troy Madsen. All right, go ahead and play along, and see if you can figure out the answer to today's situation. Dr. Madsen, today's "ER or Not" a panic attack. Is that a reason to go to the ER or not?

Dr. Madsen: That's a tough one, because I think, for some people they absolutely feel they need to go to the ER, and typically, what's going to happen is, in the ER, is you might get some medication to help calm you down, give you a little bit of time to relax, but it's probably not something you absolutely need to go to the ER for. If you've had a history of anxiety before, you may have some medication at home you could take that can kind of help calm you down. You know, take 30, 45 minutes before you make that decision to go to the ER.

Of course, the big reason to go to the ER would be if you're having other issues, as well. Let's say you're having thoughts of hurting yourself, you know, any thoughts about suicide, absolutely you need to get to the ER. And that would be the biggest thing I'd say. You know, when someone comes in saying, "I'm just feeling really anxious," they're hyperventilating, that's my first question. "Well, are you having thoughts about suicide, any attempts, anything like that, that we need to be worried about?"

Interviewer: But the panic attack itself and the hyperventilation, that's not a breathing issue, generally?

Dr. Madsen: Well, that's a great question, and I think there are kind of two things here. There may be a person who's had panic attacks before, they've been diagnosed with anxiety, they're familiar with this feeling. If you're in that situation, you may have medication, you may know how to kind of control things at home. Maybe you've tried some deep breathing, things to calm yourself down.

Now, on the other hand, if, just out of the blue, you've never experienced this and you suddenly start to feel extremely anxious, you're hyperventilating, you know, you may think to yourself, "Well, maybe this is just a panic attack," but something like a blood clot in the lungs can cause a person to feel very anxious, very short of breath. It gives you that feeling like you're going to die, something that a person with a panic attack might feel. So you've got to be careful there, and if that's something you haven't experienced before, then absolutely, I would say you need to get to the ER.

updated: May 6, 2020
originally published: September 29, 2017

Interviewer: All right. It's time for ER or Not. You get to play along and decide whether or not something that's happened is worth going to the emergency room or not. With Dr. Troy Madsen, he's an emergency room physician at University of Utah Health. Sitting around kind of minding your own business and all of a sudden you noticed like your heart's beating really fast, it's racing. ER or not?

Dr. Madsen: Yeah. Well, this is a good question because we see this quite often in the ER. And the medical term for it is palpitations when you just have that feeling like your heart's racing or maybe it's skipping a beat. So I'd say it kind of depends on the other symptoms you're having with it and how long this lasts.

If it's something that lasts for a few seconds, it goes away, you could probably just follow up with your doctor. But if it's something where it just will not go away, let's say you feel down and you feel your pulse and it's going really fast, if you're having other symptoms like you're light-headed, passing out, absolutely I'd get right into the ER.

Interviewer: All right. In the instance where you just see your doctor where if it's just for a quick moment, what could possibly be going on there?

Dr. Madsen: So one of the most common things we see when people say they have palpitations or they just have this feeling like it's skipping a beat or speeding up, we'll often see what are called premature ventricular complexes or PVC's. All that means is the lower part of the heart that squeezes the blood out, can beat a little bit early. Typically, it's not a problem.

If that happens, a lot of people have that especially when they exercise. If it's bothersome, a cardiologist can do an oblation where they find the spot that's causing that premature beat and get rid of it. But usually, it's not a serious thing where you need to rush right into the ER and get that diagnosed.

Interviewer: And it's usually something that just kind of happens once in a while?

Dr. Madsen: For some people, it happens more frequently. Others, may never even notice it when it's happening, you know. In some cases, people do feel it. They may notice it more when they exercise or they're walking, so it varies from person to person.

Interviewer: All right. And in the case of where you would go to the ER if it was continual and it lasted for a while, what could that be an indication of?

Dr. Madsen: Yes. So that could sometimes be an indication of more serious things. The most serious thing being ventricular tachycardia where your heart is just racing. And that can be a life-threatening thing. Some people may have heart conditions that set them up for that that make them more likely to have that happen. That's something where sometimes we even need to shock the heart to get it back into a normal rhythm.

Another thing we commonly see especially in older people is atrial fibrillation. Now, this is where the top of the heart, the atria, goes really, really fast. And in the bottom of the heart then senses some of those fast beats from the top and then conducts that at also a very fast rate. It also sometimes can be life-threatening because it will drop your blood pressure but in most cases, people come into the ER. Their blood pressure's okay. We can give them medications to slow their heart down or we can also, if we have to, give them a little bit of sedation and shock the heart back into a normal rhythm.

So if your heart's racing and it just lasts a short period of time, otherwise, you feel okay, I think you're okay just to see your doctor. If it's something that's going on for longer than a minute or two or it keeps coming back or you're having other symptoms with it, absolutely, you have reason to get to the ER.

updated: January 13, 2021
originally published: September 15, 2017