Runny Noses are NOT Emergencies

According to Wikipedia, the Emergency Room is a department that “provides initial treatment to patients with a broad spectrum of illnesses and injuries, some of which may be life-threatening and require immediate attention.” The important part of that sentence is the last six words.

Life-threatening and require immediate attention. This describes an acute condition: something extremely serious and critical but that is brief and severe. A chronic condition, on the other hand is one of long duration, typically described medically as one that has existed for six months or more.

Now, understand that chronic conditions can have acute exacerbations: asthma, sickle cell disease, COPD, CHF, among others. We treat these in the ED, and they’re considered emergencies.

What we don’t (or shouldn’t have to) treat in the ER: Colds. Bug bites. We won’t immunize your kids. No, that small laceration does not need stitches.

It’s perfectly ok to come to the ER if you have any doubts about your condition. But once you’re here, you need to trust our judgment. Of course there are cases when people who originally were not thought to be acutely sick became critically ill in a waiting room, as far as I’m aware they’re the exception rather than the rule.

When I tell you in triage that you (or your loved one) is currently in no danger of loss of life or limb at the present time, that while I understand you are feeling badly, but that there are people who are more ill than you and who will be seen before you, you need to accept it. Please know we’re keeping an eye on you as you wait to be called. We’re aware you’re here. Please don’t say, “But HOW DO YOU KNOW nothing’s wrong? I could be DYING right now!” (I’m SO tempted at these times to explain that we’re ALL dying, just very slowly. I’m also tempted to say, “Because it says RN after my name,” and point to my ID badge.)

If you’re an otherwise healthy 25-year-old man, and your initial complaint is of nasal congestion, fever, body aches, and cough for ONE DAY...you probably should not be in the ED. This is NOT life-threatening and does not require immediate attention. You should be at home, drinking NyQuil and hanging out on the couch. You’re sick. It sucks. Have some soup, have some orange juice, have some ibuprofen, take a nap, watch some TV. If you don’t feel better in a couple of days, call your doctor. Or go to a clinic. In the ED, we don’t have soup, we rarely have OJ, we don’t have comfortable beds, and we don’t have TV. (Though that’s about to change...ugh...)

If you’ve been to three dermatologists over the last six months to try to figure out what that gross rash is on your hands and arms, and they’ve given you steroids and creams and pills and they’re not working, and the rash doesn’t hurt and it’s not infected, and it’s not really bothering you except that it looks yucky and you really would like to know what it is...you probably should not be in the ED. Seriously, dude. You’ve seen SPECIALISTS. We’re just gonna give you a referral to a SPECIALIST.

If you’re a 65-year-old overweight man with a history of heart attack and coronary artery disease, and you come in and sit in my triage chair and are puffing like a locomotive, and your lips are a little blue, and your primary complaint is, “my feet and legs are all swollen up, and I can’t seem to catch my breath even when I’m taking it easy” and your heart rate is 120 and your blood pressure is not so great and your lungs sound like a famous breakfast cereal, then DING DING DING!! You WIN! You are having an emergency and you get to be taken back to a bed.