TraumaPosted: March 19, 2012
When most people think about an Emergency Room, they think about trauma, even though that is only a small fraction of what we do. The question is, when is trauma significant enough to warrant a trip to the ER?
Any trauma that involves a head injury resulting in being unconscious or confused is potentially serious. Continued vomiting after the head injury, or a severe headache is also cause for concern. Vision changes, loss of balance, or ringing in the ears are all potential signs of a moderate to significant head injury. If a head injury occurs with no immediate symptoms, and twenty-four hours has passed without any of the symptoms mentioned, then you probably don’t need to go to the ER. Bottom line, if you strike your head and the next thing you remember you are waking up and EMS is hovering over you, take the ambulance ride to the ER, do not refuse transport.
Broken bones can be both painful and debilitating. If you have injured your legs/ankles/feet, and can walk five steps, then you probably can wait to be seen by your own doctor for x-rays in a day or so. If you cannot bear your own weight, or have an obvious deformity, then go to the ER right away (Don’t eat on the way, in case I have to sedate you to set the bone). In the case of injuries involving the arms, if it is deformed, numb, discolored, or you cannot move it, then you need to go to the ER for evaluation as soon as possible. A good rule of thumb for fractures was taught to me by my high school football coach thirty years ago: If you THINK it’s broken then it probably isn’t, and you can wait till tomorrow, if you KNOW it’s broken then go to the ER right now. (This worked for me when I broke my hand in a game, played four quarters, and then went out drinking after the game. Although, my dad was less than thrilled taking me to be seen the next morning).
Any time you suffer a fall from a height greater than 6 feet, and have any pain, especially in the neck or in an extremity, then you need to come to the ER for evaluation. This is especially true for the elderly, and is the reason granddad should not be hanging his own christmas lights.
If you have a cut, apply direct pressure. If bleeding cannot be controlled in about 10 minutes, come to the ER. Cuts to the face that are deeper than just a scratch should be seen to prevent disfiguring scars. If cuts occur on the hands and fingers, there is a chance of loss of function due to injury of tendons, nerves, or blood vessels. Also, scarring on the hand can cause difficulty in the future. If a hand wound becomes infected, it can be very serious. Bottom line, if you have a deep cut, come to the ER within 12 hours of the time the wound occurred. After 12 hours, naturally healing has already begun, and we may not be able to stitch the wound. Also, come to the ER for any cut that may be contaminated by bacteria, or if your tetanus shot is out of date (greater than 5 years), tetanus is deadly.
It should go without saying, but I will say it anyway, if you’re shot or stabbed, come to the ER. In addition to caring for your wound, we will help you with the legal aspect of your safety. This includes assaults without weapons as well. Any trauma to the eyes warrants a trip to the ER (you only have two, let’s protect them). Also, any blunt trauma to the abdomen or chest which causes significant pain or bruising. These could be indications of internal injuries, so let us take a look.
A general rule of trauma is than if you feel fine then you probably are. If you have any focal area of pain or disability, I want you to come let me evaluate you. A pitfall to avoid is coming to the ED with no focal complaint asking to get “Checked out”. Please remember, I am not Dr McCoy, I don’t have a tricorder, and I can’t do a whole-body MRI looking for a needle in a haystack. Seek care if you need to, but if you aren’t sure why you are going to the ER, then I am probably not going to be sure what to look for.
This isn’t all encompassing, but I think you get the idea. In future blogs I will address some specific mechanisms of trauma such as animal bites and burns.
Next time: Motor vehicle accidents.