Q & A with Emergency Physician Dr. Wayne Warrington
1. When my child has a fever, at what point do I need to seek emergency care?
Fevers are a medical emergency when: they cause seizures, are unrelenting for several days, don’t resolve with appropriate doses of ibuprofen and/or acetaminophen or if the child appears lethargic, in any acute distress or associated with bizarre behavior.
2. Should I take my child to the ER in the middle of the night for an ear infection?
An ear infection, in and of itself, is not usually a medical emergency. But sometimes the associated symptoms, such as severe pain or persistent fever, can be. Getting your child an emergent dose of antibiotics is not necessary. In fact, in
Europe, most clinicians do not routinely treat kids who have inner ear infections with antibiotics. It has been postulated that our overzealous use of antibiotics has caused resistant strains of many bacteria.
3. When should I call the doctor rather than go to the ER?
If your child is not in extremis or having a severe [attack], you can probably take 5 minutes to try and get your pediatrician’s advice. He/she may save you hours of waiting in a crowded Emergency Department!! Of course, if you are concerned that your child needs to be seen right away, then my standard response is don’t hesitate to come the ER.
4. For wounds, how do I know if my child needs stitches?
If you are able to pull the edges of the wound apart or the underlying tissue is exposed, it probably needs a stitch. If the bleeding is profuse and will not stop bleeding after direct pressure, it probably needs a stitch. And remember, there is a time limit on how much time after the injury the wound can be sutured. In addition, every hour a wound is left open equals more exposure to bacteria that can form its own little colony when the wound is finally closed and there is a good anaerobic environment.
5. When is a burn an emergency?
When it causes severe pain, or when the area is charred or white and there is NO pain (3rd degree). Usually, 1st degree burns (without blisters) that resemble a sunburn do not need to be seen immediately. 2nd degree burns are usually severely painful and should be seen by a doctor for analgesia, cool towel wraps, burn cream application and prescription.
6. If my child has never had an allergic reaction before, can he have a severe reaction the first time?
Absolutely! Anyone can be allergic to almost anything at any time, and the first time can be anaphylactic shock!! Many people wonder why they suddenly become allergic to a food when it was the one-thousandth time they ate or
were exposed to it. It happens!
7. If my child is healthy and has what looks like a seizure, what should I do? What does a seizure look like?
If it is a first time seizure, you should definitely seek medical attention. If he or she has had seizures in the past, then you will know what to look for (past symptoms). There are a few types of seizures, but most of them involve a loss of consciousness, trembling all over and maybe frothing at the mouth, eyes rolled back in the head, bowel or bladder incontinence (not always) and shaking all over. A patient who can talk to you during their seizure or respond to your comments during the event is probably not having a real seizure.
8. How do I know if my child has a broken bone and whether I should call the doctor for treatment or go to the ER?
If you call your doctor with a story like that, 99% of them will tell you to come see me (in the ER) since very few family physicians have X-ray capability and it will be impossible for your doc to tell you definitively if your child has a fracture. If you suspect your child has a fracture, by all means come see us!!
9. At what point should a child with asthma be taken to the ER?
Go to the ER if breathing becomes increasingly difficult despite the use of your child’s home nebulizer system. When a child appears to be struggling to keep awake to breathe, of course you should bring him or her in. I might even call 911 in that case. If you feel the medication isn’t working and your child is working harder to breathe, by all means come see us.
10. If my doctor tells me my child is fine, but I still feel my child is sick, should I go to the ER?
Absolutely!! I am a strong believer that most moms have certain instincts that know when their child is in trouble. When in doubt, call 911.
11. If my child has the stomach flu and is vomiting all day and I have spoken to the doctor, but they say to stay at home, give fluids and rest, at what point does it become an emergency situation?
When the child is unable to keep down fluids, the child looks dehydrated (i.e., sunken eyes, dry lips, decreased or lack of urine output) or is lethargic, seek emergency help.
12. Are there times when it is better to call 911, rather than walking into the ER?
Again, if your child is in extremis, unresponsive, lethargic, or bleeding profusely… call 911.
Bio: Specialized in Emergency Medicine Wayne Warrington, DO graduated from Kansas City University of Medicine and Biosciences-College of Osteopathic Med. in 2002. He now lives and works in Hawaii.
This article was courtesy of Britt Michaelian, author of Safety Goddess Book, founder and CEO of Responsible Family Company, http://ResponsibleFamily.com
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