Should you visit me? Or "What is an emergency?"

What is an emergency? It seems that there are many people out there who don’t know the answer to this question. Can the patient breathe? Are they bleeding? Is there a bone broken? Are they awake and alert? These are the questions we attempt to answer in triage. Remember your ABC’s? In all first aid and CPR classes, the first thing they teach you is ABC, or Airway, Breathing, and Circulation. Additionally, we have added D for “Da brain”. Chances are, if all your ABC’s are in order and functioning, you do not need to go to the emergency department.

Let’s start with A and B since they go together. Is the patient moving air? If so, they are good! Even if they are coughing or have a stuffy nose, chances are they are going to be fine without any intervention. If they are breathing really fast and seem to be working hard at getting air in, they might need to be seen. One way to tell they are working hard is to look at the belly and neck. If the muscles in these areas are getting a workout, that is not so good. By all means, come see me in the ED.

How about C? Amazingly, children rarely have trouble with their heart. How about the other circulation issue, bleeding? How long, deep and where is the cut? If it is small, not on the face, not deep, and can be easily cleaned out, you are good! If not, come see me…

Da brain. Is the child lethargic? What the heck does a lethargic child look like? Can they answer questions appropriate to their developmental level? Think about how you feel when you are sick. Don’t want to eat? Want to sleep all day? When a kid is sick, they can feel the same way! Kids can get dehydrated much quicker than big people, so here are some easy ways to determine the hydration status: tears, diapers or trips to the bathroom, and moist mouth. If they have these things, they are probably ok. If not, come see me…

Do not come visit when your child has a nightmare. Do not come see me when they have a cold. Does their tummy hurt? Go to the doctor in the morning. The emergency department is not the best place to hang out when you are bored in the middle of the night. The other night, we had a family who brought their child for a cold and then, after waiting an hour, the parent asked, “Why did I come to the emergency department any way?” It was all I could do to refrain from replying, “I don’t know. Why did you come to the emergency department?”

Another issue; why do parents end up in the ED without the supplies needed for the general care and feeding of their child? I do understand that in an actual emergency, there is often no time to grab these items. However, when a family is coming for less urgent care, why do they leave this stuff home? If you were going to the mall, would you expect the shop keeper to supply a diaper, wipes and cream for changing the baby? It will likely be a long wait, maybe some books and or small comfort toys would help the cranky child who is usually asleep at this hour and now is in desperate need of a nap. I had a father the other night who demanded immediately after being placed in the room, “I need a diaper, baby wipes, and cream and a bottle with formula.” This was for an older child with special needs who required a diaper size which we do not usually stock in the ED. Fortunately; there were some in the store room.

To sum this up, if there is an issue that truly needs immediate care, come see me. If not, consider staying home and calling you doctor in the morning. Generally speaking, the doctor is less expensive and the wait will be shorter. If you do decide to come see me, bring whatever supplies you might need as the wait times can be quite long at this time of the year. When in doubt as to staying home or coming to the ED, call your pediatrician or a nurse advice line. Children’s has just such a resource which can be found online at http://www.thechildrenshospital.org/wellness/at_home/index.aspx, or by calling 720-777-6543.