Search for tag: "er"

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: Three things that kill young, healthy people. That's coming up next on The Scope.

Announcer: This is "From the Front Lines" with emergency room physician, Dr. Troy Madsen on The Scope.

Interviewer: Today we're going to talk about from his perspective in the ER, three things that can kill young healthy people. Because generally young healthy people aren't prone necessarily to dying, but there's some kind of usual suspects that you see come up time and time again. So let's start with number one. What is that?

Dr. Madsen: So number one, the one thing I see that it's just devastating to see this, but this kills young healthy people is a pulmonary embolism. This is a blood clot in the lungs. Some people are prone to these because they may have a genetic disorder that makes their blood more likely to clot. But what will happen with the clot, it often forms in the legs, somewhere else in the body, breaks through, goes to the lung. And if it's large enough, can just cause just a massive collapse of your cardiovascular system where your heart is just not squeezing the blood out like it should, and that can kill people. It's a devastating thing. We do see it occasionally, and these are very often people who are otherwise healthy.

Interviewer: Now we're talking 30, 40 otherwise athletic. A lot of times it can affect them.

Dr. Madsen: Exactly. For a lot of these people, it's their first time in the ER. They may not even see a doctor. They may have zero health conditions, no meds and this can happen out of the blue.

Interviewer: Are there any warning signs for a pulmonary embolism that they could have been aware of that might have prevented it?

Dr. Madsen: So sometimes these people may have had a small pulmonary embolism before the big one hit, and they may have had some chest pain, shortness of breath. Classically the chest pain is worse when you take a deep breath. A lot of times they describe that they just can't do their usual activities. They feel shorter breath while they're trying to walk upstairs or run or things they would typically do. These are all things to watch for and try and get some medical attention if you're having these symptoms.

Interviewer: And not be confused for maybe some other things like maybe thinking you've got asthma all of a sudden.

Dr. Madsen: Exactly. You know, usually people who have asthma have probably had asthma before. It would be unusual for that just to come on out of the blue. So if you have new chest pain, new shortness of breath, especially if that pain is worse if you take a deep breath, if you're passing out, if your heart is going really fast, all reasons to get checked out.

Interviewer: All right, go to the ER for that.

Dr. Madsen: I would go to the ER absolutely.

Interviewer: Three things that kill young healthy people. What's number two?

Dr. Madsen: So number two is an aneurysm in the brain or what we call a subarachnoid hemorrhage. This is when an aneurysm bursts. There's bleeding in the brain. This is a devastating thing, and I can think of cases I've seen of people who have come in, young, otherwise healthy people and classically they describe a severe sudden onset headache. They describe it as a thunderclap headache. It just comes on like that sound of thunder. Just out of the blue, out of nowhere, severe sudden onset, maximal intensity, very quickly and they have bleeding in their brain and that bleeding can expand very rapidly.

Interviewer: Is that caused by trauma or something like that? Or does it just come on you even if you're just sitting and not doing anything?

Dr. Madsen: So trauma can absolutely cause this sort of thing. We definitely see lots of cases of trauma, but the cases I'm thinking of are people who have not had any trauma and who just say, "Wow, I got a headache out of the blue. I don't normally get headaches. This is a 10 out of 10 headache. This hurts like crazy. My head just feels awful." Maybe they're confused. Maybe they're having nausea and vomiting. This can be a very devastating thing and, like I said, can go south very quickly if this bleeding expands.

Interviewer: So if you're a young, healthy person and you're having those symptoms, again, go to the ER immediately.

Dr. Madsen: Absolutely. I mean anyone of any age. But this is one of these things in young, healthy people that is just, again, people who may have no other medical issues, no indication of anything wrong get a sudden severe headache, get medical attention, get checked out.

Interviewer: All right. Three things that kill young healthy people from an ER doc's perspective, number three.

Dr. Madsen: So number three is trauma. And this is often one of the most devastating things we see. You know, young, healthy people sometimes are more likely to take risk, whether it be on, you know, motor vehicles, motorcycles, outdoor activities, that kind of thing. You hate to see people who are severely injured by trauma, but it's a devastating thing to see. We see lots of trauma, and a lot of those traumas are again in people who are young, healthy, otherwise have never had issues, never been to a doctor, and suffer severe trauma. Sometimes no fault of their own or sometimes maybe because they are taking some risk.

Interviewer: So I think the takeaway for me anyway, and you can help verify this, it sounds like if you're having any sort of symptoms of a pulmonary embolism or a brain aneurism, that either shortness of breath that we talked about where normally you wouldn't have that or that thunderclap headache, you should immediately go to the ER even if you're healthy because these are some pretty serious signs, and as far as trauma's concerned, just be aware that that's a danger for us young, healthy people.

Dr. Madsen: That's exactly right, yes. Pulmonary embolism, subarachnoid hemorrhage, like you said, watch out for chest pain, shortness of breath, sudden severe headaches, trauma.

Interviewer: Take it seriously.

Dr. Madsen: Take it seriously. Take the necessary precautions. Stuff's always going to happen. There's always risk in any activity, but take the necessary precautions. Wear a helmet, wear your seat belt, make sure you're safe in any kind of activity.

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Announcer: Health Hacks with Dr. Troy Madsen on The Scope.

Interviewer: What is today's health hack?

Dr. Madsen: Today's health hack is a trick to avoid a trip to the ER for a broken toe. So let's say you're walking around the house, you don't have shoes on, you hit a corner of the bed with your foot, and you immediately have pain in one of your toes. And you're thinking to yourself, "Wow, my toe hurts like crazy. I wonder if it's broken."

So your first thought is, "I need to go to the ER or an urgent care and get an x-ray." If you were to come to the ER or an urgent care and get an x-ray and if your toe were broken, we would do a simple thing. We would tape it to the toe next to it and we would send you home.

So here's your health hack. If you do hit your toe hard, you wonder if it's broken, just tape it to the toe next to it. If it's broken or if it's sprained, the treatment is the same. As long as it's aligned okay, it's moving okay, as long as the blood is profusing okay, it looks nice and pink, we're going to tape it, we're going to call it good, tell you to give it a few weeks. It should feel better. It should heal up just fine.

Interviewer: And if it is having some of those other issues, that's when you should go to the ER.

Dr. Madsen: Yes. If you look at your toe and it's kind of twisted weird or you're just not able to move it right, that's a sign that maybe it's a more serious fracture, but that's pretty rare. Most cases of fractures in the toe, we're just going to tape it to the toe next to it and give it time to heal up.

Announcer: For more health hacks, check out thescoperadio.com produced by University of Utah Health.

Interviewer: Today's health hack with emergency room physician Dr. Troy Madsen is for nausea. What is your health hack?

Dr. Madsen: Well, nausea is a very common thing we see in the emergency department, and typically it's after a person may have eaten some bad food that makes them feel sick to their stomach, or maybe they've come down with some sort of a virus. But when you come to the ER just with some nausea, there's not a whole lot we can really do for it. We may give you some prescription medications, but there are over-the-counter medications you might even have at home that you can try, and these medications are things that you may have taken before for motion sickness, often under the brand name Dramamine or Meclizine. You take these medications, they can help a lot with nausea, they can help you to keep fluids down, stay hydrated at home, and by doing so, you can potentially avoid a trip to the ER.

updated: June 3, 2021
originally published: March 15, 2019

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

Interviewer: Time for another health hack with emergency room physician Dr. Troy Madsen. What is today's health hack?

Dr. Madsen: Today's health hack is treating food stuck in your throat and just using a soda. It sounds so simple.

Now when we talk about food stuck in the throat, I'm not talking about stuck in your airway. That's a big deal. I'm talking about, let's say you have a big piece of steak, gets stuck in your esophagus, in the food tube that's taking the food down to your stomach. You know it's stuck there because every time you try to swallow, you just cannot get even your own saliva down. You're spitting it up. You think to yourself, "I've got to go to the ER and get this out."

Before you go, try this instead. Get a soda, drink it down, let it sit there. It's probably going to work. It's going to relax the esophagus. It helps to dissolve that meat a little bit, gets it down into the stomach, and you avoid going to the ER.

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

Interviewer: All right, it's time for another health hack with emergency room physician, Dr. Troy Madsen. What is today's health hack?

Dr. Madsen: So this is a great health hack, and it's one of my favorites. And it's superglue instead of stitches for lacerations. Now, in the ER, we use glue all the time instead of stitches. It's quick. You can use it on smaller lacerations, things that aren't really gaping wide-open, things where I'm not concerned about infection. And patients ask me, "Is that just superglue?" And I tell them, "It is. It's superglue that's formulated a little differently so it doesn't sting."

But if you're traveling, it's not a bad idea just to carry superglue with you. It could keep you out of the ER as long as it's not a big laceration. Wash it out really well. Make sure there are no concerns for infection, no tendon injuries, nothing like that. Put a little bit of superglue on it. It will probably hold it together great and keep you out of the ER.

updated: October 5, 2021
originally published: October 12, 2017

Interviewer: You get some sort of a cut and you go to the emergency room. What determines whether you get stitches or staples? Find out next on The Scope.

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

Interviewer: Dr. Troy Madsen is an emergency room physician at University of Utah Health. So if something happened and I end up in the emergency room, I've heard that somebody can maybe get stitches, maybe somebody gets staples, but how do you as an emergency room physician decide what it's going to be? Or do I get to choose?

Dr. Madsen: I kind of just randomly pick and then I just go for it.

Interviewer: I don't believe that. I don't think that's really what goes on.

Dr. Madsen: Yeah. No. I think of different things for different parts of the body. So you're right. We've got staples. We've got stitches. And we've got glue. So we got all kind of choices.

Interviewer: Oh, there are three. It sounds cooler though, I think, if I could tell my friends, "Yeah, I had 16 staples." as opposed to, "They glued me up."

Dr. Madsen: Oh, I know. Oh, yeah. Someone's like, "They put superglue on you. You weren't hurt."

Interviewer: Yeah.

Dr. Madsen: They're all options. They all work great for different types of scenarios. So the times I use staples are on the scalp. That's where it really comes in helpful. And the reason I use it there is because the scalp is really thick skin. Those staples hold it together really well. And scalp wounds bleed like crazy.

Sometimes people come in, they just think they're bleeding to death. You clean their head up, you look there and you see a wound that's maybe an inch long. But they just bleed a ton. And the best thing you can do sometimes is just staple it up right there. Like, we might even throw three staples and not even numb it up because the numbing medication is going to hurt more than the staples are. And I always tell patients that if you want me to numb it up, I can, or we can just get this done really quickly. So that's where staples are great.

Interviewer: All right. I have put a staple through my finger, those kind of hurt though.

Dr. Madsen: They do hurt. I'm not going to say it doesn't hurt. I'm just saying the lidocaine, the numbing medication hurts worse.

Interviewer: Okay. So in the scalp, you do staples because it's good thick skin and it really seals things up better than stitches.

Dr. Madsen: It does. It just brings it together so quickly. It's nice and tough. That scalp skin is really thick skin, so it just pulls it together and holds it there really well. And you're not as concerned about scarring there. On the face, you put a bunch of staples on the face, you're going to look like Frankenstein versus on the scalp, unless you're bald and you're really concerned about how your scalp looks, it's not a big deal.

Interviewer: All right. So then, what about stitches?

Dr. Madsen: So stitches are kind of our go-to. Pretty much anywhere else we're going to use stitches. And then it becomes what kind of stitches. On the face, we use really thin sutures, really thin stitches because they lead to less scarring. They're tougher to handle, tougher to work with, but you want them really thin and very close together, versus someone comes in with a laceration in their leg, on their lower leg. I'm going to use a thicker suture there just because I want it to hold together that skin, particularly, say over their knee, over their joint. Something that's going to be tougher, and you're not as concerned about cosmetic issues there.

Interviewer: Got you. And then glue. How long has glue been around as an option?

Dr. Madsen: Well, glue has been around . . . it's funny. It really started to be used about 10 to 15 years ago. So when I was in training, I actually had one of my attending physicians, I remember, ask me how to use glue. He was like, "What's this new stuff?" [inaudible 00:03:05] So it just kind of really came out around then. But glue works great. It's essentially just superglue. And it's changed a little bit, so it doesn't sting like superglue does. But when you look at the formulation, it's very similar to superglue, just a medical-grade sterile superglue.

And it works great for wounds that are not super big, something where it's not a gaping wound, where you really need to get that wound together. I find it works really well for kids because you don't have to try and sedate them and numb them up. You can just put some of this glue on. Personally, for me, when I travel, that's my go-to. I carry it with me because I figure if I have a laceration, it's easy enough to use. I can wash that off, glue it up. It's quick. It does a great job.

Interviewer: As a patient, if you end up in the ER, can you request glue or stitches?

Dr. Madsen: Sure. Absolutely.

Interviewer: You could always request.

Dr. Madsen: You can always ask for it, yeah. And the doctor may tell you, "Hey, this is a wound I'm concerned about. It's a gaping wound. I think we need to use sutures." But sometimes, I'll even use, say, one or two absorbable sutures, dissolvable sutures just to get that wound together. Once it's together, then I just do the superglue, just the medical glue over the top of that. And it's a nice combination, a little bit quicker. It avoids a lot of the pain. And [inaudible 00:04:20]

Interviewer: What about scarring? Does glue scare even less than sutures?

Dr. Madsen: It's similar. Studies that have been done that looked at outcomes after gluing versus suturing showed similar cosmetic outcomes. I can't say . . .

Interviewer: Oh, really? Okay.

Dr. Madsen: Yeah. People would be a little more concerned, maybe the stitches are going to hold the wound together better, but the studies that looked at outcome showed that it was similar.

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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.

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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: How should you handle an overdose situation? We'll talk about that next on The Scope.

Announcer: Health tips, medical news, research and more, for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: Hopefully, this is a situation you never find yourself in, but, in the event that you happen to be around when somebody is having a drug overdose, what should you do? Dr. Troy Madsen is an emergency physician with University of Utah Health. What should I do? That could be very scary I'd imagine.

Dr. Madsen: It can be. So drug overdoses, you think of a lot of different things. You can have people who just accidentally take too much of their medication, people who are taking opioids or illegal drugs and overdose on those, or people after suicide attempts who may take any of a number of different medications. And we see all of these in the ER. So I think the number one thing is, you got to get them to a hospital, and if it's as serious thing where they're not breathing, obviously, you've got to get 911 there and get them help as quickly as possible.

The other thing you can always think about is if you live with someone or if you are someone who uses opioids, potentially has an abuse problem, you can get naloxone. This is a medication that reverses opioid overdoses. You can get it through EMS departments, through state health departments, county health departments, and it's something that can absolutely be lifesaving. It reverses the effects of opioids, obviously that's a huge issue in the country. It's a huge issue in the state of Utah, I think we're number five or six right now in terms of opioid overdose deaths. So, if you have that issue, if you know someone who does, have that medication around.

Other overdoses we think about are things like, I mentioned like suicide attempts, and they're really serious thing there. It can be things like Tylenol, opioid medications again, things that make you stop breathing, some of the heart medications that can cause big heart problems. There, there's not a lot that you can do emergently.

I would tell you one thing not to do it, is not to make the person vomit. And some people may think, okay, person swallowed a bunch of pills, let me stick something down their throat or have them try gag themselves to vomit this back up. That can just create worse problems because if they're already a little bit drowsy or they're trying to vomit this stuff up, they can then breathe that into their lungs and that can make it a lot worse. So you don't try and do that.

You may have heard someone say, "I went to the ER and got my stomach pumped, someone put a tube down there and sucked everything out," we don't even really do that anymore. We just found out that the risk of aspiration of breathing that stuff into lungs was much greater.

So I would say the number one thing to do, any of these overdose scenarios, make sure the person is breathing okay, make sure they're alert, get them to the hospital, if it's a time dependent issue where they're not breathing well or they're drowsy, get 911 there, have naloxone around for people who have potential opioid problems or abuse issues and make sure that they get the help they need.

Interviewer: I'd like to back track just briefly here. What's that fine line between having too much and going to be okay versus going to go into an overdose situation? How do you make that call? What should I look for?

Dr. Madsen: Yes, that's a really tough call, because in medication like Tylenol, you may not know that's a serious overdose for several days. But, you've got to get the treatment for it as quickly as possible. So, if you live with someone and they're just not sure how much of the medication they took, it's going to be really tough just to look at that person, say, "Well, they're probably fine," because if they took too much of their blood pressure medication, they may act okay, but their heart may be in an abnormal rhythm that could then worsen to a life-threatening rhythm.

So it's hard to say, just look at how they look, look at how they're acting.

Interviewer: Really kind of follow your gut on that sort of a deal.

Dr. Madsen: You do.

Interviewer: What about like illegal drugs.

Dr. Madsen: So illegal drugs, yeah, I mean there it's . . .

Interviewer: If somebody is passed out after doing illegal drugs, would you call someone for it?

Dr. Madsen: Yeah, you really do. If they're passed out, you know, you don't know if they're just going to come to within an hour or so, versus are they passed out and they're just not breathing well and they're potentially having severe brain injury because they're not getting enough oxygen? That's really a tough situation. But I'd say, if they're not responding, you really need to get them to the ER.

Interviewer: Something not to mess around with?

Dr. Madsen: Yeah.

Interviewer: What about myths? You had mentioned one, that you want to get somebody to vomit up whatever it is they had, which you say, don't do because it just causes more problems. What about you got to keep somebody awake and they're going to be okay then?

Dr. Madsen: Yeah, you know, I guess it's more just monitoring them to see if they're staying awake, but if it's at that point where they're nodding off and you're really worried they're not going to stay awake, you really need to get them in for help because at that point, yeah, I mean, you're going to be trying . . . some of these medications are going to last at least four to six hours. And some medications they overdose on could last 24 to 36 hours. So you've got to get them in and get them help. You can't just sit there and try and keep them awake for hours on end, exactly.

Interviewer: What about privacy concerns? Because if I was in that situation and somebody overdosed because of illegal drugs, for whatever reason I happen to be there, if I call 911, now I'm afraid that there's going to be a bigger problem on the other end of it for everybody.

Dr. Madsen: Yes. That's a common concern. In the ER, everything is private. We're not reporting someone for drug use. I've never asked the police to come and arrest someone for drug use, that's just not something that happens. So don't let that stop you from getting help. All those things, things not to worry about and things, they're not going to be prosecuted for.

Interviewer: So don't play the what if game.

Dr. Madsen: Right.

Interviewer: If you truly are scared, probably best just to call 911.

Dr. Madsen: Exactly. Best to call 911, best to get them to the ER. understand that we see these sorts of things all the time. The good news is, 70, 80% of that time things are fine, the other 20% of the time, we may need to keep people for a while and admit them to the hospital to start treatment.

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Interviewer: How to handle a bloody nose that doesn't seem to want to stop bleeding. Emergency room Dr. Troy Madsen, what should a person do?

Dr. Madsen: Bloody noses are a very common thing that we see in the emergency department and these can be very messy and, sometimes, really tough to stop. But the thing I tell people, the key is if you're at home, hold pressure on your nose. Don't hold it on the bony part of your nose. Hold it on the soft part of your nose on the outside and hold pressure for 15 minutes. You'll be really tempted after two or three minutes to let up and look, but just keep holding pressure.

If you look after 15 minutes and it's still bleeding, hold pressure for another 15 minutes. Look again, if it's still bleeding, another 15 minutes. So three times total. If it's still bleeding at that point, you may need to come to the emergency department, but 95% of the time, this is going to work. Most times, it's going to keep you out of the ER.

updated: February 22, 2021
originally published: January 25, 2019

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

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, let's see you how you do today. ER or Not with emergency room physician Dr. Troy Madsen. I'm going to give you the scenario. You decide whether it's worth going to the ER or not. Here is the situation, Dr. Madsen. You're helping some friends move some furniture. You lift a particularly heavy chest of drawers. You feel a little bit of a pop in your abdomen area. Now there's, like, a protrusion down there. ER or not?

Dr. Madsen: Well, this is something, I think we've all done it sometimes, lifted something, you know, these moving scenarios, you're often trying to show off, you know, your strength, trying to carry some piano down the stairs. And as you're doing it, you say to yourself, "This was a really bad idea." But then, when something pops out in your belly . . .

Interviewer: "This was a really bad idea."

Dr. Madsen: Then you think, "This was a really bad idea." So it's not uncommon. We'll see people in the ER with hernias.

Interviewer: That's what that is.

Dr. Madsen: That's what it is. So a hernia is a tear in the lining of the abdomen. And when that muscle tissue tears there, and those fibers tear, then some of the contents of the abdomen can kind of bulge out. So that's intestines that are kind of sticking out there that you're feeling beneath the skin. You've got this bulge, often around your belly button. A lot of people experience it in their groin as well, particularly men. When you had your physical exam and the doctor touched you and said, "Turn your head and cough," he was checking for a hernia. That's what we're doing there.

Interviewer: Just kind of making sure you didn't have one and didn't realize it.

Dr. Madsen: Exactly. Just a small one, something like that. So that's exactly what a hernia is, it's a defect in the wall, but it is not a reason to rush to the ER.

Interviewer: What are you talking about? My insides are coming out. It's absolutely a reason.

Dr. Madsen: Exactly. It's scary. The one time you'd want to rush to the ER would be if something changes with that hernia. And most people know they have hernias. It's happened to them. They've had hernias for years, and they know it's there and they just kind of deal with it. You can get it surgically repaired, but it becomes an emergency if it becomes what's called an incarcerated hernia. And that's a strangulated hernia.

So that's when you get enough of this stuff outside of the abdomen that the blood supply gets cut off to it. You try and touch it, it hurts, it's firm. You try and push it back inside, which you should easily be able to do, and it won't go back in. That becomes a very big deal, and it's definitely a reason to get to the ER. Often in the cases, we have to get these patients to the operating room pretty quickly to get this treated.

Interviewer: Okay, so just to be square here, I'm moving furniture or I'm lifting weights and I get that pop-out. Just because it's not a reason to go to the ER, I should go see my doctor.

Dr. Madsen: Yes, you should. Yeah, because it could get worse.

Interviewer: But it's not something I have to do, like, then.

Dr. Madsen: It's not.

Interviewer: In the next couple of days. Unless, of course, it becomes painful to touch and I can't push it back in, then a trip to the ER is necessary.

Dr. Madsen: That's right. Most people with hernias live with them for years, but if something changes, you'll know it. Get to the ER.

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