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Sure Signs You May Need the ER, Says This ER Doctor

In the coronavirus era, here's when it's essential to seek medical advice.

You don't have to be a doctor to know that certain symptoms require immediate medical treatment—if you are experiencing chest pain, or you are drooping in your face, you need to get to the Emergency Department for evaluation for heart attack or stroke. But there are many other signs or symptoms that are less well-known that are just as concerning and should be evaluated in the Emergency Department. 

As an Emergency Physician, I find it increasingly important for patients to know what symptoms can be evaluated by a primary care physician and which ones require a trip to the ER. If you are able to spot some of the concerning symptoms yourself, you may be able to get the care you need as fast as possible and have improved outcomes. Read on, and to ensure your health and the health of others, don't miss these Sure Signs You've Already Had Coronavirus.


Sweating Associated With Chest Pain

Elderly caucasian sweating and fainting.

The feeling of having an elephant sitting on your chest is a concerning sign of possible heart attack. What is not as well known is that sweating associated with chest pain is equally as concerning. This is not just sweating as if you were sitting in the middle of New Orleans in August in a wool suit, but rather sweating even when you feel cool, and possibly even in a cold room. Chest pain that is associated with sweating is a predictor of a heart attack and needs to be evaluated as soon as possible.


Difficulty Speaking

Woman in a blue shirt talking to herself.

Although stroke is commonly thought of to cause weakness in an arm, or the face, it can also cause problems speaking. For example, one may be able to speak but the words are jumbled or gargled. Or one may be unable to speak although they are able to think of the words. But either symptom should be evaluated immediately in the Emergency Department even without the presence of weakness or numbness. 


Ulcers in Your Mouth After Antibiotic

Young woman is looking on her tongue in the mirror

Ulcers in the mouth, or even in the genitals after taking antibiotics. Although it could be a common allergic reaction, concerning reactions such as Stevens-Johnson syndrome also present with mouth sores.  


Burns Involving Joints

heat burn wound on her hand.

Although many burns will not require much, if any intervention, burns that involve joints such as your wrist, elbow, or knee will need close monitoring. As burns heal they can cause very tight scars that will make it difficult to use the part of your body that is affected.


Woke Up With a Bat In Your Room

bat (Pipistrellus pipistrellus) flying on wooden ceiling of house

Although not a specific symptom of health, waking up with a bat in your room is a reason to come to the Emergency Department. There is a risk of contracting rabies from bats even if only in the room with an infected animal.


Shortness of Breath After Long Trip

Young man having asthma attack at home

After long travel, such as transcontinental flights or long car rides where you are seated and not moving around for an extended period of time, the risk of having blood clots increases. If you have shortness of breath after prolonged immobilization you should be evaluated by an Emergency Physician.


Injury By a Power Washer or Paint Sprayer

worker with high pressure washer cleaning house facade

Although you may think this injury will cause some short term pain that can be monitored at home, this can be a surgical emergency. The pressure that is emitted at the tip of the device is so high that it can actually inject the water or paint deep into the tissues. Many times it requires an operation to treat completely.


Swallowed a Button Battery

button cell battery

There are many objects that when swallowed only require observation to make sure they pass. Button batteries, however, are not treated this way. They can actually create a small current when they contact the tissue of the stomach or intestines, and can burn a hole through the lining of your gastrointestinal tract. Therefore they need to be evaluated, and most likely removed, immediately. 


Blood Sugar Machine Reads "High"

Man taking blood sample with lancet pen indoors

Specific to patients who are diabetics, but if your finger stick machine reads "high" at any point, you should be seen in the Emergency Department. Although it may be benign, it also could be a symptom of other more concerning processes such as Diabetic Ketoacidosis or DKA. Many times, DKA requires you to stay in the hospital, sometimes even in the intensive Care Unit. (ICU).


Falls on Blood Thinners

Prescription pill bottle medicine

Falls are obviously a common reason people come to the Emergency Department but for individuals who are on blood thinners such as warfarin, or apixaban, the concern is much greater. Even minor falls can sometimes lead to bleeding into the brain that requires further treatment.


Nail Through Your Shoe

man holding a hammer to nail concrete floor

This is specific to people who have underlying diabetes. If somehow a nail sticks through your shoe and into your foot, this needs immediate care. Diabetes can cause specific infections due to the reduced blood flow, especially in feet.  It is important to start antibiotics quickly to minimize the risk of these infections.


Shortness of Breath 7-11 Days After Positive Covid-19 Diagnosis

Curly woman feeling bad and suffering from strong cough while having flu

With all the talk about COVID-19, you may feel that any symptom would require an Emergency Department visit. Although these symptoms can be scary, many of them can be treated at home. More data is coming out that if you are symptomatic from COVID-19 and are having worsening symptoms in the 7-11 day time period, it may be best to be seen in the ER. If you have any concerning symptoms at any point after diagnosis a discussion with your Primary Care Physician is a good first step. And to get through this pandemic without catching coronavirus, don't miss this essential list: Most COVID Patients Did This Before Getting Sick.

Dr. Kenneth Perry is an active practicing physician and Medical Director of an Emergency Department in Charleston, South Carolina. 

Kenneth Perry, MD FACEP
Dr. Perry is an active practicing physician and Medical Director of an Emergency Department in Charleston, South Carolina. Read more about Kenneth
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