Life in the ER: Emergency medicine cases and tips

As an emergency medicine physician, my job is to figure out what is wrong – and quickly. Then, I identify what actions are necessary.

Here’s an example: An elderly woman is brought in by ambulance. Her vital signs are normal, but she sounds like she has marbles in her mouth. In this case, you might test her for low blood sugar or examine her for an infection.

If someone can’t speak, but is aware of her surroundings, my first thought is stroke. Most people’s speech center is on the left side of their brain, next to the area that would control the ability to move the right side of their body. I asked this patient to raise her right hand. She could comprehend the command, but couldn’t move that arm. When a stroke is suspected, I alert the hospital’s stroke team to rush to the Emergency Care. The next actions are standard. The patient has a CT scan of her brain, blood is drawn and her kidney function tested. Because the hospital uses a high-tech CT scan with a dye that lights up the brain’s vessels, we can easily see a clot and treat her quickly to prevent brain damage.

That afternoon, this patient was sitting up, talking and moving her arms. This is the type of case that makes me excited about advanced medicine. And a tip: “Time is brain.” Get your friends and loved ones to the emergency room if you suspect they are having or had a stroke.

In another case, a female with fever, chills, diarrhea and dizziness came into the Emergency Department. She had a rapid heartbeat and a high fever. We asked, does she have a flu? She was flu negative. A urinary tract infection? Food poisoning? Pneumonia? In this case, it was sepsis. Sepsis is when you have an infection that overwhelms your body. It can affect your kidneys, heart and liver, and can put you into shock or kill you.

In the Emergency Department, a “code sepsis” alert brings an organized hospital team running to the patient. They take blood and urine specimens for diagnosis, chest X-rays, an electrocardiogram on the heart, and perform additional tests. We give the patient IV fluid and antibiotics immediately. We know early treatment with antibiotics saves lives. Her sepsis started as an infection or her urinary tract. The infection spread into her kidneys, which acted as a portal for the infection to get into her bloodstream. The take away here? Don’t wait to go to your doctor if you don’t feel well. Luckily, she made a full recovery, because we have learned so much in the last five years about how to treat sepsis.

A common complaint that brings people into the Emergency Department is a sore throat. If someone has a sore throat caused by a virus, an antibiotic won’t help or cure them of symptoms. However, a sore throat might be a sign of strep throat, which should not be ignored. Untreated strep could progress to rheumatic fever, which causes issues in your joints and can harm your heart. There is an easy way to determine if you have strep or a virus. Typically, strep will involve four symptoms: a high fever, white spots on your tonsils, swollen glands and no cough. If you have a cough and a running nose, typically strep can be ruled out. If you think you have strep symptoms, seek medical attention.

Not everyone is thrilled to need emergency attention. Sometimes, there are long waits to see a doctor, especially when a critical patient needs immediate care. We try our best to figure out which patients are the most critical and to treat everyone with respect and kindness. There are many great, knowledgeable doctors in this field, but at Northern Dutchess Hospital, we believe that listening carefully and our relationships with patients are top priorities.

W. Andrew Wilson of Kinderhook is the medical director of Northern Dutchess Hospital’s Emergency Department and is board certified in emergency medicine. He joined the hospital’s medical staff in 2012.