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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

Recording: Medical news and research from University of Utah physician and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: When you live in an area with beautiful mountains and beautiful valleys a lot of times people want to get out and enjoy them. Sometimes they take it to an extreme. Even not when you're taking it to an extreme you can get hurt out there.
We're talking with Dr. Brown. He's an orthopedic surgeon at the Teton Valley Medical Center. Let's talk about some of the injuries you see in this beautiful country that you have here. What are some of the more common orthopedic injuries?

Dr. Brown: Lots of injuries occur in the back country. In the winter I see lots of ski and snowboard injuries and a lot of snowmobile injuries. In the summer it's the entire gamut: golf, fishing, rock climbing, mountain climbing and you name it.

Interviewer: Just getting out and doing something you can potentially hurt yourself.

Dr. Brown: Right.

Interviewer: Do you any thought or any tips for people as to maybe minimize their risks when they're participating in whatever it is they enjoy?

Dr. Brown: Just pre-plan, precondition, get in shape, have the right equipment and make sure you know where you're going. If you haven't done it before, go with someone who has.

Interviewer: What are some of the more common reasons you would see somebody coming in here? Is it because they didn't plan well enough? Is there one that's bigger than the others?

Dr. Brown: Certainly the most common is bad luck.

Interviewer: Okay, so it's just something you can't control.

Dr. Brown: A series of events conspire against you and you break or tear something.

Interviewer: Yeah. Would you say that those were preventable or at least you could see it coming?

Dr. Brown: Not always, that's part of the thrill of being out there. You're not on a Disney Land ride. Anything can happen, and I think that's part of the impetus and the satisfaction that people have going into the back country. I know that's what I like about it. I like going out and knowing that there's some risk. You control it as much as you can, but that's part of the enjoyment for sure.

Interviewer: Let's wrap up with this last question. It's going to happen. If I'm with somebody and something severe happens to them, what should I do for them at that point? A lot of times you don't have cell reception, you're not able to call. Do I leave them and run to get help? Do I try to get them out?

Dr. Brown: Good questions. Like I said, preparation is the key. If you go back in there in the back country you want to have some backup plans. I can tell you my group, I'm a back country snowmobiler, so most of the time we're back there where we're nowhere close to any type facilities. There's no communication. There's no cell phone service, so we have GPS radios that we can contact one another and even if someone's unconscious, you can pull where they are and find out where they're at.
We try not to go with less than three or four guys. We have GPS locators. The brand we use is called a Spot. If you're in deep trouble you can push 9-1-1, and even if you're out of cell phone range you can get help.

Interviewer: So there's some technology now that's has really changed things.

Dr. Brown: Yeah, for a couple of hundred bucks you and your group can have an emergency plan for getting help in that. It can mean a difference between living or dying, but more importantly it can mean the difference between two of the most miserable hours you've ever had and 26 of the most miserable hours you've ever had.

Recording: We're your daily dose of science, conversation and medicine. This is The Scope, University of Utah Health Sciences Radio.

Dr. Madsen: So, you've got something wrong. Do you call the ambulance, or do you drive yourself in? How do you make that decision? I'm Dr. Troy Madsen, Emergency Physician at the University of Utah Hospital, and we're going to examine that today on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You are listening to The Scope.

Dr. Madsen: So, let's say something happens to you. You're at home. Either you're having some symptoms like some chest pain or some cough. So, you're thinking to yourself, "I don't want to call an ambulance. I don't want to call 911 and tie up an emergency line there. I don't want to have to take an ambulance trip in, when that could be using it when someone else needed the ambulance." Then there's the cost, too. An ambulance costs $500 to $1,000 for a trip in the ambulance. So, you don't want to have to use that, as well.
So, it's a tough decision. It's something that's probably worth thinking about beforehand, before you're in that situation and have to make that decision. So, the biggest thing I'd tell you is the time to call an ambulance is-think ABC's. If you're having trouble with your airway, where you feel like your airway is blocked off. If you're having trouble breathing, where you can't get a good breath. And let's say you have asthma, and you just cannot breathe. Or you're having chest pain with the C, the circulation. Anything that's going to affect your body circulation. Or you are bleeding profusely; you're losing blood. Those are all reasons to call an ambulance. They're going to get you to the treatment you need more quickly than just driving yourself in.
Of course, if you get in a car and you're having trouble breathing, you could potentially black out and put others at danger as well. So, keep that in mind if it's something where you driving yourself could put others in danger. The other of course is, let's add on a D onto the ABC. D is for disability. If this is something that could cause a long-term disability-the big thing I'm thinking about here is a stroke. If you're having numbness and weakness on one side of your body, difficulty speaking, that's something where time is of the essence. And the faster we can get you to the ER, the better we can treat you.
If this is anything where time is of the essence or getting care sooner is going to make a difference. Strokes are one of those things where time is of the essence. If you cut off a finger or a toe, that's one of those situations where the sooner we can treat you and the sooner that the surgeon can get that re-implanted, that's going to make a difference as well.
Teeth can make a difference, too. Let's say you get a tooth knocked out. You know, the best thing to do in that situation is get that tooth. You can put it in some milk to preserve it, but the sooner we can get that tooth back in, the better chance it has of survival.
So, if it's something where time is of the essence, where time can make a difference, getting an ambulance there quickly can definitely help you out. And we always in the ER would rather err on the side of maybe someone coming in by ambulance who maybe didn't need it, versus someone not coming in by ambulance, and something bad happening because they didn't get the care they needed.

Announcer: We're your daily dose of science, conversation and medicine. This is The Scope. University of Utah Health Sciences radio.