Is Chapped Lips An Emergency?

One of last year’s fun news stories was a 911 call from a man whose cat wouldn’t let him in his house.  After a three hour stand off, and after the police and 911 operator finished laughing themselves silly, an officer was dispatched and apparently talked the cat down.

Similar absurdities happen in Emergency Medicine.  Once when I worked in Baltimore, a mom brought her child in for chapped lips.  Thinking that no one would come to the ED for such a minor thing, I searched for the “hidden agenda,” some underlying worry explaining mom’s thinking.  Like if her Uncle Frim had lip cancer and she feared her son had it too. However, after an exhaustive history, there was no such issue: her son simply had chapped lips.

It’s sometimes difficult telling the public when to call 911 or not, and when to bring kids to the Emergency Department or not.  We want to encourage people to get emergency help so they don’t blow off potentially serious issues.  On the other hand, we don’t want the Emergency Department and EMS systems clogged with non-emergencies.

Most pediatric ED visits are not emergencies, but families come for many reasons. First, parents get scared for their kids.  They love their kids and when they get sick or hurt, parents sometimes rush for help rather than call their doctor for advice or wait for an appointment.

Often parents can’t get their kid seen in the office that day.  An appointment for next week doesn’t help when your child won’t stop vomiting, or needs x-rays.  Sometimes when the parent does call for advice, the mom is told to go to the ED, rather than office staff taking time to talk the situation through, giving advice that could keep the child home.

Sometimes when a child gets sick or hurt, a doctor’s office or school is worried about caring for a potential emergency.  They aren’t used to emergencies and don’t want to miss something, or get sued.

Almost daily we see kids in the Emergency Department who were in car crashes, seem fine, but the parents want them “checked out.”  You can’t fault this reasoning; they care about their kids and are worried.  However, when the “crash” involves cars backing into each other in a parking lot, and the child was strapped into a car seat, maybe an ED visit is overkill.  Unless the lot has cars speeding into their slots like the Indy 500 pit stop.

Too often the ED is used as a walk-in clinic, rather than for true emergencies.  The point of this blog is to inform you about what real emergencies are, what can wait to see the doctor, and what you can take care of at home.  So let’s review common issues appropriate for the ED, and things that are not emergencies.

Kids who are short of breath, tugging to breathe, belong in the ED.  Of course bring any children with possible broken bones, cuts that need stitches or won’t stop bleeding, or severe pain. When kids get lethargic (difficult to arouse), they need to get seen.  However, there are gradations of cuts and limb injuries, and lethargy: kids with fever get lethargic, but recover with anti-fever medicines.  If it isn’t obvious if it’s an emergency or not, call the doctor’s office.  If they can’t help, go to the column in this blog to the immediate right side of the page.  Click on your issue to read specifics about what is an emergency, and what can be handled at home.

Things that are commonly not emergencies: fever, coughing, rashes.  Fever doesn’t hurt kids- it doesn’t cook their brains and is rarely associated with seizures.  The height of the fever doesn’t correlate with how sick the kid is either: a child with a 104 temperature isn’t sicker than a child with 101.  Coughing also isn’t an emergency- kids cough when they get colds and if they aren’t otherwise short of breath, it can wait.  Again, see the column to the right.

This is a busy time of year for the Pediatric Emergency Departments, so use common sense when deciding to visit.  Use your doctor’s call line, or this blog when in doubt.  But if you still can’t decide, bring your child in. Better safe than sorry, but you can leave the chapped lips at home.

Non Emergencies in the Emergency Department

I walk into the room, introduce myself, and ask my usual lead-in question: “When did things first start going wrong?”  The mom answers “She started with this rash last night, and this morning it has spread all over.  Just look at it!”  The mom yanks up the toddler’s shirt and sweeps her hand to show me the extent of the child’s scourge.

And the child’s skin looks….normal.  I put on my reading glasses and peer closer.  Still, I am hard-pressed to identify anything that could be remotely called a rash.  The mom offers: “Its those bumps that worry me.”  Ah yes, I can see that the child’s skin has tiny bumps that at first you don’t notice, but alter the skin’s texture a little bit.  I straighten up, complete the rest of my history and physical, and inform the mom that no, the child does not have measles or chicken pox or flesh-eating bacteria, but a dry, irritated skin condition called eczema.  A change of soap, more lotion, and it should be fixed up in a few days.

Winter is a busy time in the Pediatric Emergency Department.  Bronchiolitis makes babies cough, influenza makes all ages feel and look miserable, and asthmatics wheeze.  Kids are kept indoors by the cold and cough on each other and spread the contagion.  Emergency Departments and doctor’s offices are filled to the brim with sick children.  And then everybody waits longer to see the harried practitioners.

The majority of theses illnesses involve coughs and fevers.  Fevers and coughs are not emergencies, and there are some simple things to know that can keep you from having to wait for hours in the Emergency Department or at your doctor’s.  Fever itself is not an emergency.  Fevers do not harm your child- they do not cook kid’s brains and they rarely cause seizures.  Fever is actually one of the body’s natural mechanisms to fight illness- fever is a good thing!  When your body senses that you are sick, it sets your brain thermostat higher.  The higher body temperature makes it harder for infection to grow in you, and your immune system can get on top of the infection.

What is more important with fever is how the kid is acting with the fever.  Certainly the child will be tired and miserable, but that is easily treated with medicines like ibuprofen (motrin, advil) or acetaminophen (tylenol, pediacare).  As long as your child is drinking some, breathing comfortably, and is mentally “with it,” your child is doing okay. Most fevers are caused by viruses that will pass in a few days without need for a prescription.

Likewise, most coughs are not emergencies.  Sure, coughs are irritating, particularly at night when everyone wants to go to sleep.  But as long as the child is breathing comfortably, then home remedies are as good (or better!) than any prescription.  Put your kid to bed with their his head elevated, get the vaporizer going next to the bed, put on some Vicks-Vaporub.  Give some ibuprofen or tylenol to ease that scratchy throat.  Don’t waste your money on cough syrups- science has shown over and over that they don’t work.

There is no prescription that reliably helps coughs either.  Everyday I get parents who ask for a prescription for colds.  As I tell them, no one has invented any medicine that helps dry up runny noses or suppresses cough.  Doctors sometimes prescribe anti-histamines, codeine, or other things, but these medicines rarely help and often cause more trouble than they are worth.  They can make a child more awake and antsy and irritable, and the kid still coughs!

So please don’t be like the mom above and rush to the Emergency Department when your child has a rash or a fever or a cough.  We are busy enough with the children who are lethargic or working hard to breathe, with kids with broken arms and head injuries and lacerated faces.  Long lines of the non-emergent just makes everyone wait longer, only to be told the things that could have been done at home.  If you are not sure, call your doctor to see if you should come to the office or come to the ER.  Do your part to keep non-emergencies out of the Emergency Department.



The ER Is NOT for Colds and Diaper Rashes!

It is a busy time of year for us in the ER business.  Besides the usual injuries and illnesses, people fill the ERs in the evenings with worries that are NOT emergencies.  The waiting rooms are clogged with milling crowds, often irate because of long waits, passing germs to each other, and most of those people could have stayed home and been fine. 

Why are our evenings so busy?  People get off work, come home to a sick child; now the doctor’s office is closed, so they bring the sick child (no matter how minor the illness) to the ER.  Also, there is something about when the sun goes down that increases people’s worries.  Minor illnesses are blown up to big worries in parents’ minds at night.  Doctors’ phone services are also to blame.  When some parents call their doctors at night, rather than go into a thorough conversation that can figure out the problem and help the family stay at home, the doctor or nurse just say “go to the ER.”

Here is a list of minor illnesses that should NOT be brought to an EMERGENCY department.  When families with these complaints check in, other childrens’ care will be delayed while we wade through these non-emergencies: rashes (especially diaper rashes!  In an Emergency Department?!), fever, cough and runny nose, sprains that the patient can walk on, car accidents that happened on a previous day, toothaches, pregnancy tests, diarrhea, vomiting only once or twice or less than a few hours, pink eye, pinworms, ear pain, sore throat.  All of the above should wait to see your regular doctor the next day.

Here are some of the emergency versions of the above: shortness of breath, fever with worsening fatigue, abdominal pain with worsening vomiting and poor drinking, fever in a baby less than 3 months old, injury with deformity or inability to walk, worsening headaches with any of these. 

This evening, do yourself and your ER workers a favor: call your doctor before coming to the crowded ER and waiting hours, if you are not sure if your child’s condition is an emergency. 

 Also, you can look to this blog to read about common illnesses and injuries, and how you can take care of things at home (look to the Categories column on the right side of this page).  All the entries here talk about what can be taken care of at home, and how, and what makes your child’s problem a real emergency.