It’s often hard to know whether we should go to the ER or not. This is especially true when we have a loved one with chronic health issues. Here are important signs that mean you need to go to the ER now!

1. Signs of a stroke

Signs of a stroke- No matter how mild they seem. These include weakness or paralysis of one side of the body or of an arm or leg as well as drooping of the face or deviation of the tongue to one side. May also include inability to speak, slurred speech, or speaking gibberish. If the tongue is involved, don’t have them eat or drink anything because their swallowing reflex could be affected and they could choke.

For a stroke, time is of the essence. In order for a clot buster to be given, there is a small window of time in which to do it. Find the quickest, safest way to get your loved one to a hospital with a good neurology department, to be checked to see if they can qualify for this treatment. Early treatment makes a huge difference in their prognosis. Often, the quickest way to get them to the hospital is via ambulance, but it is a judgement call you have to make. In rare situations, you may be able to get there faster. Do not drive yourself because you could lose consciousness!

This acrostic may be helpful in sorting out signs of stroke: Face drooping
                                                                                            Arm weakness
                                                                                            Speech difficulty
                                                                                            Time to call 911

• NUMBNESS or weakness of face, arm, or leg, especially on one side of the body

• CONFUSION, trouble speaking or understanding speech

• TROUBLE SEEING in one or both eyes

• TROUBLE WALKING, dizziness, loss of balance or coordination

• SEVERE HEADACHE with no known cause.  (from American Stroke Association)

These are all warning signs of a stroke and you need to get to a hospital to be treated whether you will be eligible for a clot buster or not. The longer you wait, the more damage will be done.                                                                                                 

2. Symptoms of a heart attack

Signs of heart attack– symptoms can vary considerably. The pain can be crushing chest pain or it can be pain that radiates from the chest to the jaw and/or down the left arm. It can also include pain that radiates to the back. Women tend to have more variety in the kind of pain/discomfort they have, for a variety of reasons. There may be shortness of breath.

Unless you are next door to the hospital, it is wise to call the ambulance because they can have the IV started and have the patient monitored on the way to the hospital. Definitely don’t drive yourself to the hospital if it is possible that you are having a heart attack because your heart could stop on the way from an arrhythmia.

The 5 common symptoms (you may experience some) are the following: (from American Heart Association)

• pain/discomfort in the chest
• light headedness/nausea/vomiting
• jaw/neck/back pain
• discomfort/pain in arm or shoulder
• shortness of breath

3. Shortness of breath or respiratory distress

Respiratory distress– any shortness of breath that isn’t their normal should at least be checked out with a call to your doctor for his recommendation and possibly a trip to the ER. Pneumonias and other complications are easy to come by in this group of people. They don’t always have a fever and low oxygen levels tend to complicate quickly! This is especially true if their color is becoming bluish and you don’t have oxygen available.

If you own an oximeter (the little thing that doctor’s office clips onto your finger to check your oxygen level), check to see what the oxygen level is. If it is alarmingly low, have the patient take a few deep breaths and recheck it. It should be in the high 90’s. The ambulance might also be a wise call for that as well depending on the degree of distress the patient is in. They have oxygen available and the patient can be monitored.

4. Fever or worsening confusion in an elderly person

Fever or confusion– In elderly people, fever isn’t always as common right away like it is for younger people, when they have an infection. Sometimes a fever doesn’t come until a person is becoming septic (when the infection is getting into their bloodstream). So if he is getting unusually confused, check his temp in case he has a fever. Whether he does or not, call the doctor.

Often, a pneumonia or urinary tract infection is brewing. If it is during office hours, they may be ok for you to bring in a urine specimen. They may want to check a blood count. If it is not during office hours, you may need to go to either an ER or urgent care to have those checked along with a chest X-ray. Frequently, confusion is the first symptom of infection unless they are frequently urinating and it is clear where the infection is starting.

5. Severe abdominal pain. It doesn’t have to be appendicitis to be serious

Severe abdominal pain can often be a sign of a medical emergency as well. There are a variety of things that can be problematic in the abdomen beside the common appendix (right lower abdomen ) or gall bladder issues (right upper abdomen). Some can require surgery. Others don’t. But the person needs to be checked out and treated. Catching the problem before it is a huge medical emergency is best. Of course, if it is accompanied by bleeding either from the rectum or if they are vomiting blood, you have an big emergency on your hands.

What should I take with me to the ER?

• Photo ID for the patient
• Insurance information including medicare and supplemental insurance info if you have it
• List of all medications patient takes– This includes name, dose, frequency as well as any vitamin supplements.(I keep these on my phone so they are easy to update and handy when I need them at the hospital or doctor’s office.) If you don’t have a list, toss your medications into a bag and take them with you.
• List of allergies and meds patient doesn’t tolerate for other reasons.
• Notebook or app to write info in as well as questions for doctors/nurses/social workers
  These are the essentials.

I recommend taking along basic things for your loved one like:

• toothbrush, electric shaver
• or female toiletries
• pj bottoms, (he/she will likely have IV’s and be wearing a hospital gown top)
• comb/brush
• phone/charger
• CPAP machine if he uses one and is admitted. (They will use his machine.)
• You can leave them in the car in a bag in case he is admitted. You don’t want a lot of stuff in the ER, just the basics. You can alter this list for your specific loved one. You know what makes him/her most comfortable.

This list is mostly for you

Take along whatever you need to be comfortable while you wait.

• always take a sweater or wrap of some kind.
• your phone & charger
• something to read
• earphones so you can listen to things on your phone if you prefer while he is sleeping.
• I also take my computer and plug so I can write.
  There is always lots of time spent waiting. Always! You don’t want to be miserable. Be
  prepared. That way you can be calm for your loved one and calm to ask
  the doctors the questions you need to.

Encouraging Words

“Fear not, for I have redeemed you;
I have called you by name, you are mine.
When you pass through the waters, I will be with you;
and through the rivers, they shall not overwhelm you;
when you walk through fire you shall not be burned,
and the flame shall not consume you.
For I am the Lord your God,
the Holy One of Israel, your Savior.

Because you are precious in my eyes,
and honored, and I love you,

Isaiah 43:1b-4a ESV

**Next week: we will talk more about emergencies: how to manage them, how to communicate better with your Doctor, how to feel more confident doing it.

***This is a post written on May 27,2020 and slightly updated for this series.