I think that patients need to have more patience. Some people rush to the Emergency Room for conditions that can safely wait to be evaluated by a physician in 24 to 48 hours. This waiting strategy can save you both time (if you have ever gone to the E.R. on a Saturday night with a non-life threatening problem you know what I mean) and money (if you have ever received a bill from the E.R. you also know what I mean).
As the summer is upon us, I will discuss several common conditions that patients often seek immediate care for but that can safely wait a period of time. These include sprains, cuts, and insect bites or stings.
Most people with an injury to a bone or joint are concerned whether or not there is a fracture. This is a reasonable concern as an untreated fracture or one not treated in a timely fashion can lead to long-term impairment or prolonged recovery.
Despite rumors to the contrary, being able to move a body part does not guarantee that there is no fracture. Many patients have walked into a doctor's office with a broken foot or ankle. An obvious deformity can make finding a fracture more likely, but unless you are Superman, you need an x-ray to detect a non-displaced fracture.
Fractures that require immediate attention include open fractures in which a bone is protruding through the skin and displaced fractures that compromise circulation. The former condition is readily apparent even to the untrained observer. The latter condition is detected when there is a decrease in pulse, coolness to touch, or pallor distal to the site of injury.
The vast majority of fractures can be managed with the use of rest, ice, compression, elevation, and over the counter pain medications until an office evaluation can be performed. Ideally this should be no later than 2 or 3 days after the injury.
Cuts require immediate attention if bleeding cannot be stopped with direct pressure. Otherwise relatively clean cuts can be sutured up to 19 hours after the injury. A longer delay increases the chances for infection.
A tetanus booster should be given within the first 24 hours of the wound if one is needed. A patient with a dirty or deep wound should receive this if more than 5 years have elapsed since the last booster while a patient with a clean or shallow wound only needs a booster if over 10 years have elapsed since the last booster.
Patients who step on a rusty nail should be seen immediately as these wounds should be anesthetized and thoroughly cleansed due to their extreme risk of infection. This prompt attention is even more important if the patient has a compromised immune system from diabetes or other chronic illness.
A bite from a mosquito or tick will take several days to cause symptoms if a disease has been spread. There is no known benefit from prophylactic antibiotics with these. If a fever or rash develops in the week or so following the bite, evaluation should be sought within a day or so.
A sting from an insect should prompt immediate medical attention if the patient has a history of severe allergic reactions to them in the past or if the patient develops hives or any breathing difficulties. Otherwise ice and oral benedryl can be utilized. If significant swelling or itching at the site of the bite occurs despite these measures, a physician can be consulted in a day or two.
While many common conditions are painful and frightening, the above guidelines can help the patient determine which ones require immediate attention from a doctor and which ones can be safely treated hours or days later. This knowledge will help avoid unnecessary trips to the emergency room after doctors' offices and urgent care centers are closed. The patient's patience can result in dramatic time and cost savings.
