May 7, 2014

Interview Transcript

Interviewer: Top five reasons people might end up in the ER. Think about what you think they might be, and you'll find out next on The Scope.

Intro: Medical news and research from the University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: One of the top five reasons people come in the ER. We're with Dr. Troy Madsen, University of Utah Hospital Emergency Room Physician. Let's go over the top five reasons somebody might end up in the ER. Number five.

Dr. Troy Madsen: This is based on actual research we've done. So we looked at patients who come into the Emergency Department, and we try to quantify why did they actually come in. The number five reason on that list was back pain, and oftentimes this was an acute back injury. Maybe they twisted their back or just stood up wrong or something happened. Or sometimes it's chronic back pain. It's pain they've had for years, and they come into the ER for this.

Interviewer: Let me ask you one question further. Is that a reason to go to the ER? Should you go to urgent care?

Dr. Troy Madsen: It is a reason to go to urgent care. The reason to come to the ER is if you're having any bladder or bowel something, like, where you just cannot urinate or you can't hold it, like, you just urinate on yourself because then we actually worry more about spinal cord compression.

Interviewer: Okay.

Dr. Troy Madsen: The other reason to go to the ER is if you've had an injury to the back, like, direct trauma to the back, something that could cause a fracture.

Interviewer: All right.

Dr. Troy Madsen: Again, another reason to go to the ER.

Interviewer: But just a pain or an ache?

Dr. Troy Madsen: Yeah. Just aches and pains, especially these chronic aches and pains. It's probably a better reason to see your primary care doctor.

Interviewer: All right. Number four. Reasons people might end up in the ER.

Dr. Troy Madsen: Number four reason is coughing and congestion. A lot of upper respiratory symptoms. So they just got a cold. They're just feeling kind of miserable. Maybe they have a fever along with this, but this is a very common thing we see in the Emergency Department.

Interviewer: Just the kind of coughing that doesn't stop? I could never imagine going just because I'm coughing.

Dr. Troy Madsen: Yeah. And one thing you're going to find as we go through this list, you'll find a lot of things here that maybe you could not imagine going to the ER for. But when I think I started working in the ER, that was the biggest thing that surprised me. It was a lot of the kind of more minor things that we see on a regular basis, but, you know, I think people get very concerned. They may just have really, quite honestly, just a cold. But for whatever reason, they're concerned that something more serious may be going on.

Interviewer: Again, coughing. Is that a reason to go to the ER or is it more of an urgent care situation?

Dr. Troy Madsen: That's a great thing to go to an urgent care for or see your primary care doctor.

Interviewer: All right.

Dr. Troy Madsen: The exception being is if you have underlying immune system disorders or if you're on chemotherapy, anything there where you have a fever is going to be more concerning and is a reason to go to the ER.

Interviewer: Or you just can't breathe.

Dr. Troy Madsen: Exactly. Yeah.

Interviewer: All right.

Dr. Troy Madsen: If you're just not breathing, your lungs are really tight with asthma or something like that.

Interviewer: Top five reasons people come into the ER. Number three.

Dr. Troy Madsen: Number three is chest pain. We see a lot of chest pain, and this is definitely something to come to the ER for. This is something that's very concerning, especially in older adults. Once people start to get into their 50's or even older, and especially if you have risk factors for heart disease. If you have high cholesterol, high blood pressure, any family history of heart attacks, it's absolutely a reason to come to the ER, and it's one of the more common things we see.

Interviewer: Number two.

Dr. Troy Madsen: Number two is trauma and orthopedic injuries. We certainly see a lot of people after car accidents, people who were brought in by the ambulance and then people who walk in themselves either were seen at the scene of an accident and released by the ambulance but drove themselves in for some pain. Or people who have traumatic injuries from falls, from orthopedic injuries such as twisting their knee, hurting their legs, you know. So here we're talking about a full spectrum of traumatic injuries, you know, very serious. The things that, you know, maybe are kind of more sprains or strains. Things like that.

Interviewer: Is there a way that a patient could make the determination whether, again, they should go to urgent care or the ER for something like that?

Dr. Troy Madsen: You know, my general rule of thumb is, "If it's something that's from a car accident, and it involves your spine, your chest, or your abdomen, these are things to go to the ER for. If it's something where you've twisted your knee but you can put some weight on it, and even if you're having some trouble putting some weight on it, still, it's a great thing to go to an urgent care for."

Interviewer: All right. Top five reasons people come into the ER. Number two.

Dr. Troy Madsen: It works up to number one.

Interviewer: Oh. Top five reasons people come into the ER. Number one.

Dr. Troy Madsen: Number one. The top reason we see people and the most patients we see are abdominal pains, surprisingly. It's up to maybe about 25 percent of patients we see are there because their stomach hurts. They may have had some nausea, some vomiting, maybe some diarrhea, maybe just some cramping, or maybe it's something more serious like an appendicitis or cholecystitis, which is their gall bladder being infected. So we see kind of a full spectrum of things there as well, but that is the number one thing we see in the Emergency Department.

Interviewer: And the same question, how do I know if it's maybe just an urgent care or primary care physician issue versus coming into the emergency room?

Dr. Troy Madsen: Yeah, and this is always kind of a tough one, but I often, you know, think of the more serious concerns in the abdomen being on the right side. So the right lower side is your appendix. The right upper side is your gall bladder. If you're a lot of pain in those places, if you push in there and it hurts, and even more concerning if when you release, it hurts even worse, those are signs that you should probably go to the ER.
But, again, there are things where they could probably see you in urgent care, or if your doctor could get you in that same day, they can probably see you and evaluate you.

Interviewer: Is there some place you could call before you maybe make that call if you're on the fence?

Dr. Troy Madsen: Usually, calling your doctor's office might be helpful. Sometimes it's a little tough because you're probably not talking to your doctor. You're probably just talking to someone answering the phones. So it's a little bit tough, but see what you can do there.

Interviewer: All right. So just use your best judgment?

Dr. Troy Madsen: Yes. Use your best judgment. If you're concerned, come into the ER. And I think the biggest take-home point from this list is if you come into the ER and you think it's not that serious, trust me, there have been people there with much less serious things than what you have. So err on the side of caution, and don't feel ashamed if you need to come to the ER.

Outro: We're your daily dose of science, conversation, medicine. This is The Scope, the University of Utah Health Sciences Radio.


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