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When to go to the ED in the summer

Dr. Demangone  

Michael Demangone, MD, is a physician in the Emergency department at Page Hospital.

Question: Summer has started -- can you tell me when it is time to go to the Emergency department for all the mishaps that seem to happen to my family during this time of year?

Answer: Cookouts, warm weather, swimming and sun --the same things that make summer so relaxing make it prime time for injuries. While no one wants to spend a sunny afternoon in the emergency room, it's always best to err on the side of caution. Here's how to tell whether some most common summer mishaps justify trips to the emergency department.

Food Poisoning
What do you do if you suddenly realize that the potato salad you ate sat out in the sun a little too long? Let things take their unpleasant natural course-it's your body's way of purging the toxins in spoiled food. However, if you can't even keep liquids down, or if you're still vomiting, are dehydrated from diarrhea or have a fever after 24 hours, visit the ED for intravenous fluids and anti-nausea medication.

Cuts
Bare feet and sweat-slippery hands often lead to accidents. The American College of Emergency Physicians recommends going to the ED for cuts that:

  • are still bleeding after five minutes of applying direct pressure
  • are long and deep
  • are over a joint
  • remove all of the layers of the skin, like those from slicing off the tip of a finger
  • have damaged underlying nerves, tendons or joints
  • are over a possible broken bone
  • are caused by a crushing injury
  • have an object embedded in them
  • are caused by a metal object or a puncture wound

Call 911 for abdominal cuts that cause moderate to severe pain, neck or chest cuts that make breathing difficult, eye injuries or bleeding that doesn't slow during the first 15 minutes of steady, direct pressure.

Sunburn
Whether you forgot the sunscreen or you're taking medication that makes you unusually sensitive to the sun, you know just how unpleasant a bad sunburn can be. It's red, it's itchy, it hurts-but it's probably not an emergency. However, too much swelling and blistering can make you dehydrated. If you feel weak and dizzy, an ED visit may be in order.

Although it's rare, it is possible to sunburn your eyes if your sunglasses or goggles don't block glare and UV rays-and that can lead to permanent vision problems. Seek treatment right away if you experience severe eye pain or extreme sensitivity to light after a day outdoors.

Dehydration
Before you hit the beach, pack your car with the essentials, toys for the kids and most importantly, plenty of water. Healthy adults should drink 11 to 16 cups of water per day, and even more during high temperatures or while engaging in physical activity. The effects of dehydration can be mild or severe, from a dry mouth and low blood pressure to kidney failure. If you’re thirsty, that’s a good sign that you’re already mildly dehydrated. If you’re spending time in the sun this summer keep hydrated with a water bottle throughout the day, avoid drinks containing caffeine and keep an eye out for these signs of dehydration:

  • Mild: increased thirst, dry mouth, crabbiness or irritability
  • Moderate: flushed face, extreme thirst, dry and warm skin, decrease in urine output, dark yellow urine and dizziness especially when standing
  • Severe: weakness, lethargy, cramping in arms, legs and stomach, headache, a fast but weak pulse, confusion, cold hands and feet, fainting

It is recommended that you seek out Emergency Care for symptoms related to moderate to severe dehydration.

Insect Bites
Bug bites are painful and annoying for everyone, but for roughly one in 20 people, they can cause a dangerous allergic reaction called anaphylaxis. Bees, wasps, yellow jackets, fire ants and hornets are the most common culprits, although some people get similar (but milder) reactions to spiders, ticks and biting flies.
Not sure if you or someone else is at risk? Watch out for these symptoms:

  • hives, itching or rash in areas not near the sting
  • swollen lips or eyelids
  • swelling in the throat
  • wheezing or difficulty breathing
  • decreased consciousness

Anaphylactic shock is extremely serious and potentially fatal, so if you notice even mild symptoms, get help immediately.

If you've had a severe reaction to insect venom once, you may have a 60 percent chance of reacting again in the future. If you already know this is a potential medical issue for you, don't leave home without an EpiPen (prescribed by your health care provider), an easy-to-use syringe of epinephrine to counter the allergic reaction. If you're stung, tell someone nearby where your EpiPen is so they can treat you if your allergic reaction comes on too quickly for you to get to it yourself. Administer the epinephrine first, and then go to the emergency room.

Getting to the ED in One Piece
If you're experiencing chest pain, impaired consciousness, bleeding that won't stop or difficulty breathing, you need to get to the hospital as quickly as possible. However, trying to drive yourself to the emergency department could endanger both yourself and others. So, don't get behind the wheel.

To help ensure your safety, let someone else handle the transportation-a friend or a cab driver if necessary, but preferably trained emergency personnel with a well-equipped ambulance. This is not an opportunity to show off your fast driving. Call 911 and the help will come to you.

Reviewed June 2010

Page Last Modified: 06/08/2010
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