Want insights from an emergency room (ER) insider? Listen to someone who's spent more than 10 years handling emergencies in several types of ERs: my old friend Karin Berger Sadow, MD. She's currently medical director of PM Pediatrics, an urgent care center in Mamaroneck, New York. She's also the former director of the pediatric emergency department at Mount Sinai Hospital in New York City. Here are her most important emergency tips:
1. Don't give your child anything to eat or drink if there is a possibility that she may need sedation or anesthesia for a surgical procedure. We see children who need immediate surgery, but we can't sedate them, because the parent gave them food in the waiting room or on the ride over. Bad idea! So if you think there's a chance your child will need anesthesia or sedation to treat an injury or illness -- such as surgery to treat abdominal pain or a procedure to realign a broken bone -- don't give her anything to eat or drink on your way to the ER or while you're waiting there.
2. Say what you see, not what you read. Patients will say, "My daughter's lethargic and has labored breathing," because they just read those terms when looking up conditions on the Internet. That tells the ER doctor nothing. If a doctor says, "The child is lethargic and has labored breathing," it means she's semiconscious and likely needs to go on a ventilator immediately. When a parent says it, it means she's sniffling and watching TV instead of running around. "Respiratory distress" is another term to avoid. About 10 parents a day say their child has respiratory distress. Thankfully, we see only one child a week who really does, and that child usually needs to have a breathing tube inserted. So say what you see. Is she limping? Is she cringing in pain after coughing? Nodding off at the dinner table? Say that -- don't use medical terminology.
3. Say the magic words. If your child's symptoms have worsened while you've been waiting to be seen, tell the triage nurse, "My child's getting worse." Then describe what's changed. You won't be able to show the triage nurse if it isn't true, but if it is true, you will get his or her attention. It means what was written down on the form 3 hours ago may not be valid now.
4. If necessary, ask for a "doctor-to-doctor" call. If you've been waiting an excessive period of time (over an hour), you really believe your child needs to be seen immediately, or his condition is getting worse, and you cannot get the triage nurse to notice you, call your pediatrician and ask him or her to call the ER again. Ask your pediatrician to speak directly to one of the ER docs to let them know you're waiting to be seen.
