Urgency or Emergency? Is it an Urgency or an Emergency?

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The summer is a great time for kids to let loose. School is out and there is an array of ways to have fun. Unfortunately, the summer is also an opportunity for injuries and illnesses to put a lid on your children’s good times.

Parents are often faced with the problem of deciding where to take their child for care when there is a medical or traumatic problem during the summer. You should always consult with your primary care provider for medical advice, but here are some tips to help you decide where your child can receive the most appropriate treatment.

Is it life- or limb-threatening?
Emergency Department
This should be an instinctual response and there should be no delay in seeking care. If your child cannot breathe from a severe allergic response to a bee sting or a severe asthma attack, immediate treatment should be instituted with medications such as an EpiPen and transferred to the nearest emergency department via EMS. This is also true for active seizures and altered mental states, which can occur with some heat-related illnesses. If your child faints for an unexplained reason, this is also a good reason for evaluation and management in an Emergency Department where efficient appropriate testing—including blood work and electrocardiograms—can be performed. If your child falls off the monkey bars or severely cuts a finger and the extremity has signs of poor circulation (bluish discoloration), or bleeding is difficult to control, then the emergency department, again, has the appropriately-trained personnel, equipment and resources to manage these emergencies.

Is the child sick but able to hold fluid down or breathe without difficulty?
Urgent Care.
If your child had too much cake and hot dogs at a summer barbeque and developed vomiting or diarrhea, then the primary care or urgent care provider should be able to assess the degree of dehydration and give medications and fluids to help your child feel better. Likewise, if she is exposed to a trigger for her asthma and develops some wheezing that is mild, but not completely improved with medication at home, then evaluation and treatment at the primary care or urgent care site is appropriate.
Is your child acting normally after an injury?
Urgent Care.
Children often fall during activities and may bruise their head, and extremities. They may even get minor cuts. If there is only minor swelling and pain then simple measures like ice and painkillers (like Advil or Tylenol) will give you a clearer picture on the level of medical care needed. Simple cuts can be cleaned and glued at most urgent care centers and if there is continued pain in an extremity, these sites often have X-ray capabilities to see if a fracture is present. Sometimes, after a more severe fall, the child may need an evaluation at the emergency department, especially if there is loss of consciousness or the child is not acting “right.” If there is no loss of consciousness and the child is acting normally, then the child can be seen at the primary care or urgent care center for evaluation of a possible concussion. In general, if your child is not acting right or having an inordinate amount of pain after an injury, despite supportive measures, then your child may best be served at an emergency department—preferably one with expertise in dealing with children.

Has the illness been going on for a while and is not severe?
Urgent Care.
There are many rashes and bites and fevers and colds that occur during the summer. Primary care providers are experienced in treating these conditions and it is helpful for them to know of your children’s illnesses to better treat them in the future. However, urgent care centers may be convenient with their location, with hours of operation and staff and medical supplies all conveniently housed together.

In conclusion, making the right decision of where your child should receive medical care does not have to be daunting. Emergency departments are always available for life and limb emergencies, complex injuries and medical problems. They can take care of most other problems as well, but the primary care provider and urgent care center may offer favorable options to families and kids on the go. BC

Dr. Richard Lichenstein is the director of pediatric emergency medicine research at the University of Maryland School of Medicine and a pediatric emergency physician at the University of Maryland Medical Center.

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