Welcome back, everyone. Another episode of Emergency Minute. This is John Parente. I'm here with you today to discuss where do I take my sick child? We're going to talk about pediatrician's office versus the urge of care versus the emergency department. But before we get started, I wanted to reference an upcoming podcast that I did with my good friend doctor Dustin Portella, everyone's favorite dermatologist from Idaho who trained with me many years ago. And he and I talk about emergency medicine. We talk about dermatology because that is his specialty. And we talk about a very important issue that I think all of you want to know more about, which is manscaping. Yes, that actually happened. So look forward to that. It won't be on this particular channel, but it will be pretty much plastered all over the earth with his tremendous following.
Healthcare is broken. There's no question about it
All right, so speaking of followings, don't forget to follow me on social media at Drjparente. You can follow me on TikTok, Instagram, Facebook and YouTube. None of you guys are following me on YouTube. Kind of hurt my feelings. So today we're going to kind of sort out the gray area. And I've gotten a few listeners that have contacted me and said, we need to talk about do I take my child to the pediatrician's office? Do I take my child to the emergency department? Or, God forbid, the urge of care, the dreaded urge of care. So now, there are some obvious things that I think people probably know. Most people know, like if your kid's arm is falling off, you know, you're not going to the pediatrician, you're going to the emergency room. If your child needs a checkup or, you know, their immunizations or just something, that's very simple. Of course they're going to go to the pediatric, the pediatrician. So we're going to sort out some of this stuff here today, kind of the stuff in between there. Now, a couple of things. You know, first of all, I've said this a billion times on this show. Healthcare is broken. There's no question about it. But even this here today, even at its entry point, • is broken. People don't know where. Where do I take my child? Should I call a pediatrician? Should I call the ER? No, don't call the ER, because we don't give medical advice over the phone, and we say that 783,000 times a day. But the other, you know, piece of that is that, you know, urgent care is popping up all over the place. Like Medspas. everybody wants to have an urgic care and staff them, with people that have almost no training. So • • there's obviously a lot of, in between here. But even when it does work, it's still far from perfect. Right? Like, I've talked about that before. • But, the biggest thing here is that people have to understand • limitations, and not just in ER or the system, but just healthcare in general. But unfortunately, they don't. Everybody wants to drive through McDonald's and get their meal served to them very quickly, very cheaply, and economically, and then go about their business five minutes later, and they kind of approach healthcare the same way. And that'd be great if it worked that way, but it doesn't. We don't often get our answer in the emergency department. I say this all the time, and nobody likes to hear this, but the vast majority of patients that present to an emergency department with abdominal pain leave with a diagnosis of • abdominal pain, which means that we don't find anything. And that's okay. That doesn't mean that there's nothing wrong, but people have to understand and sort of gauge those expectations that, like, look, we may not find everything we need in just a couple of hours. In the emergency department, you know, these things sometimes take time to present, and they take days or weeks. Like, neurologic things can take weeks or months, or years sometimes, before people actually arrive at a diagnosis. So understand that there are limitations. That, doesn't mean that someone's done something wrong. We live in such a society that is just this blame culture. You got to point the finger. Something. Something bad happened to my kid, therefore, it's someone's fault. Well, no, it may not be. It could just be the disease process and progression. So it is a broken system, but we'll touch base on that a little bit as we get down into the weeds here of some of these topics.
The requirements for nurse practitioners in Ohio are absolutely abysmal
Before we get started, though, I wanted to do a couple of disclaimers. The first disclaimer is this. This is not meant to be medical advice. If you feel that you or your loved one or your child needs to go to the emergency department, by all means, please do so. Do not take this podcast as me saying, do not go to the ER, because that is definitely not the case, especially with children. Like, you know, I've got three kids. I get it. You know, people get nervous, people get scared. We always talk about pediatrics is treating not just the patient, but the parents. Right? I mean, that's a big part of it. But that's okay. That's our job. You know, we're supposed to educate people on whatever that disease process is or why patients and parents should be reassured that there's not anything too horrible going on. The second disclaimer is that I do not want to offend any of my mid level colleagues, specifically nurse practitioners. I've talked about this very openly on numerous podcasts before nurse practitioner training, at least in the state of Ohio and presumably the rest of the country, although I did not take the time to look at the other 49 states and what the requirements are. But the requirements for nurse practitioners in the state of Ohio is absolutely abysmal. Absolutely abysmal. You can become a plumber with far more training than, becoming a nurse practitioner. The number of hours is, is absolutely abysmal. You can do it online, you can do it without any training by a physician, which is crazy. And, you know, you don't even get procedural training, you know, laceration repairs, etcetera. A lot of urgicares are going to be staffed with nurse practitioners. So that is something that you have to kind of keep in mind. And again, disclaimer, there are good nurse practitioners out there. They do exist. I'm not taking any shots at any particular person or anything like that. I'm just overall, the system is absolutely broken, and the vast majority of nurses I know are all becoming nurse practitioners because it's so simple to do. What's not so simple, then, is taking care of people without any sort of supervision on the other side after the fact. But that's a whole other discussion for another day. So my apologies if I offend anyone. That's not my goal. My goal is to simply be very honest and factual, and the training right now is just very, very pitiful when it comes to requirements. So talk about the three levels today. Obviously, the pediatrician, I guess you could throw a family doctor into that urgent care versus the ER. You know, obviously a pediatrician is going to be, you know, for the most part, they're going to be board certified. They're going to go through all of medical school for four years, then they're going to go through their pediatric residency as well for several years. This is very extensive training. Right. And then you have your ear doctors. I'm not going to belabor that point. We have at least a three, if not four year residency on top of medical school as well, just literally hundreds of thousands of hours. And then you have nurse practitioners who I think in the state of Ohio, it's like four or 500 hours are required, and then physician assistants who end up doing several thousand hours of training and their requirements are a lot higher. And also they're taught by physicians for the most part, not other mid levels. So that's kind of your breakdown of the three levels now. So the pediatrician's office I'm not going to speak to very much because I, I'm not a pediatrician. I don't work there. But I do tell you, I see plenty of kids in the emergency department. So I think the vast majority of those visits that you should go and take your child to the pediatrician is going to be, you know, checkups, immunizations, you know, your annual physical follow ups from the emergency room. If you do happen to end up in the emergency room and you need a follow up appointment, like they're there for you. And some places do walk ins and things like that. But we've talked about this before, that healthcare is very broken. It's very difficult to get in to see your doctors. But I think the one area that sort of, debunked that are the pediatricians. Pediatricians actually usually do a pretty good job of taking some walk ins or some same day appointments because, you know, things happen to little kids and then parents get anxious and they want to take them in, and that's. And that's fine. I think there's a place for that. You know, a lot of family physicians and internal medicine docs and obviously, you know, cardiologists and specialists. I mean, you know, you'll be dead and buried by the time you get to see one of those guys. So that's going to be kind of like the office setting type of appointment that you're going to be taking your child to now. We'll talk about later on in the show, just kind of very specific complaint specific visits, age specific visits as well. But for the most part, that's kind of the pediatric office. Now, the urge of care, you know, obviously, I have a personal bias here, is pretty much run almost exclusively by nurse practitioners or pas. It can also be by resident physicians • or physicians who are, like, retired or they're, you know, psychiatrists on the side trying to make extra money. So understand that if you go to an urgent care, there is, like a 0% chance that you are going to see a board certified emergency medicine physician. Now, you know, to the average person, you're like, I don't care. I don't care who I see. Well, there's a difference there, I promise you. That's like saying, I want to play in the NFL, and you know, I've that expectation, but really, it's m more like pee wee football. I mean, there's a difference between • someone who's board certified versus someone who's just sort of, you know, kicking the tires on the side. So we see, unfortunately, these disasters in the emergency department all the time, and that's part of the reason why I'm somewhat jaded in this regard. There's this sort of national movement that, oh, you know, pas and P's are cheaper than docs, so we should just replace all of them or, you know, cut back on ours for physicians. And this is happening across the country, and nobody even knows it, except for people that are in healthcare. So, obviously, I have a personal bias here, but it's. It's based on what I see and what I do every day. There's literally websites out there, specifically, like, Facebook groups and things like that, that keep track of just absolutely disaster cases, and just completely mismanaged, patients. Obviously, it's not open to the public and things like that, but it's very eye opening to see what happens when you put people who have very little training in charge of people's lives. We just had a case this week that was sent over by one of my good friends. I don't want to mention the name because I don't want to get anybody else in trouble here, but this was a nurse practitioner that had done an outpatient workup for chest pain on this individual and had ordered all these random, weird tests that have absolutely no bearing on chest pain whatsoever for blood work. Then proceeded to order a d dimer to check for a blood clot. Okay, that's fine. • But then ordered a CT of the chest, but there was not what's called a CT angiogram, which is how you check for a blood clot. • But, like, why would you order the CT chest? Unless, like, if the d dimer was positive and you needed to rule out a blood clot, then, yes, you would order the CT angiogram. But they ordered the wrong CT, • • and then the d dimer ended up coming back, quote unquote positive. So they sent the patient to the emergency department anyways. And lo and behold, if you do what's called an age adjusted d dimer, it was actually negative. So this patient basically got sent to the ER for no reason at all. So this stuff happens all the time, because people order tests, they don't know what the hell to do with them, and it's really unfortunate. So again, I would be very careful going to an urgicare with anything • • substantial, and we'll kind of talk about that later.
The emergency room, obviously run by board certified emergency medicine physicians
Now, the emergency room, obviously run by, for the most part, board certified emergency medicine physicians and then NP's and pas that we work side by side with now in this type of environment for the most part. And what I see, you know, a lot of these MP's and pas are being supervised by the physician on some level. Maybe not like 100% like, you know, helicoptering over their shoulder, but they are involved. For example, when I work, I do look at every single thing that's being done as far as medications being ordered. I do look at, every single x ray that's taken in the department, even if the patient is not, you know, quote unquote mine. If it's somebody that's really sick or, you know, needs intervened upon or is really, really having trouble, then I'm going to be there. I'm going to be there side by side with the MP, with the PA, • • working with that patient. So I think in the emergency room, there is an opportunity to sort of supervise a little bit better, as opposed to potentially like an office setting or something along those lines. Now, the other thing I'll tell you about the emergency department, however, is that there just simply aren't enough board certified ER physicians to staff every ER in America. So you will go to an ER at some point in your life where you may not be seen by a board certified ER physician. There are some ers that, you know, have, you know, critical access or things like that, where, you know, they just have to have a family physician that happens to have had worked in the department for like 20 years or something along those lines. The entire country is moving towards having, you know, ers being run by board certified ER physicians because they value their training. They understand it. Now, 30 years ago, people were like, oh, you guys are just, you know, glorified triage nurses, you know, which is always the running joke that we love so much to hear. So, you know, I think that there are some limitations there. But understand, for the most part, you're going to be seen by a board certified ER physician, which is, you know, that's kind of what we do. Again, I can't restate this enough. If you feel the need to take your child to the ER, then please do so.
When do you take your child to the ER versus the pediatrician's office
Let's talk about some complaint specific guidance here. So, fever, you know, that's probably one of the most common reasons on earth why a child or a parent will seek out medical evaluation. • • So when do you take your child to the ER versus the urgent care versus the pediatrician's office for a fever? Well, clearly, if it's been there for at least an hour, you call 911 and go to the ER. Yes, that has happened. We see this all the time. We see patients that have had a fever for an hour that come to the ER, and it makes us homicidal. All right, not really homicidal. That would be weird. But it does drive us crazy. Like an hour, like, that's the benchmark. Sometimes I wish I could speak my mind and say, why did you wait so long? Spent a whole hour? Did you take a Tylenol? So, you know, this obviously becomes an area. Fever is very sort of a. It is objective 100.4 or higher, but it's more subjective in severity. Right. Like, is this something that needs to be seen in the emergency room, or is this something that can go to the pediatrician's office? And this is where this gets into a very gray area here. Very hard to put parameters on this because people aren't, like, checking vital signs at home. Like, yes, if your child is hypoxic, you know, you definitely want to come to the ER. Well, most people don't have pulse ox at home. You know, if your child is tachycardic and their heart is racing, you should go to the ER. Well, fever does make your heart race. So by definition, every single kid on earth with influenza needs to go to the ER. By the way, spoiler alert, they don't. So, you know, there are very, it's very difficult to put parameters on where. Where you go. So I think my message for fever would be, if your child looks toxic and look, every. Every parent that's out there will look at their child with a fever and be like, oh, he's just not himself. He just. He's lethargic and all these things. Understand that that's different than what we look at in healthcare. As, you know, board certified docs, when we say a child looks sick, that means something different than when a parent says, my child looks sick. Of course your child looks sick. He's pale. He or she is pale, you know, not eating or drinking as much. Probably curled up, on the couch like a ball, not really eating or drinking as much. You know, not no longer interested in playing video games, you know, things like that. That's obviously alarming to parents. But as a physician, that's not alarming. That's. That's completely normal. That's, completely normal to feel that way with fevers. When physicians use the word lethargic, it means something completely different. It means someone that has, like, hypotonia, like, less muscle tension and tone, and they can't hold their head up, and they can't really open their eyes and things like that. So there's different variables here where it's very difficult to say • • who looks sick • • that needs to come to an ER versus someone who's got a runny nose, and they're still playing video games, and they look fine, and then they can go to their pediatrician. • • You know, this sort of has to be that gut feeling for the parents. And if you're ever really not sure, you know, I would just say err on the side of either a calling the pediatrician and kind of getting their advice on where to go from here. If they can't see you, obviously, then come to the emergency department. I don't know that I would go to an urgent care with a fever unless it was something simple like, hey, I need a strep test. You know, my child's got a sore throat. Like, that's kind of hard to screw up. Like, I mean, you do the strep swabs. You know, there are some. There are some pitfalls. Don't get me wrong. You could have peritonsular abscess, which someone has to be able to identify, because that needs to be seen by an Ent physician. We see that all the time in the ER. There's other things, too. Like, you know, if the patient's had sore throat for a week, and they say, oh, you got strep throat, and they put you on antibiotics. But really, it's mono. You know, you could develop a rash. It's not life threatening, but still, it's a pain in the butt. So there are some pitfalls with even something as simple as sore throat. But for the most part, I think the urge of care is like, hey, I just. I really want to get a strep test, because if it's positive, my child needs antibiotics and to be off of school today. If it's negative, we don't need antibiotics, and it's likely viral and my child can go to school today or the following day. So I think, you know, fever is very difficult to put parameters on, but I think that's where I would start. Now, part and parcel with fevers, you know, most common thing that we see in, the emergency department regarding fevers would be respiratory complaints, especially in the middle of winter. So upper respiratory infections, you know, bronchitis, pneumoniae, we do see the sore throat, like I talked about before, and then ear infections, both inner ear, and then occasionally the outer ear, especially in summertime. We do see the swimmers here. So the respiratory stuff, sort of the infections, upper respiratory. This is going to be more age dependent. So, you know, a fever in a three week old is a much bigger deal than a fever in a three year old. Right. I mean, that's, that's the, you know, we start to look at categorizing these children. So newborn, basically up until weeks of age, you know, fever is pretty huge deal. Up until three months of age, you should still, you know, go to the, at least the pediatrician, if not the emergency room. And then after three months of age, that three to six months, your immune system is more fully developed. At this point, this, becomes less dangerous. You still seek out evaluation, but this is when you start to get into teething, especially if the child's in daycare. You can get the, you know, all the viruses that do occur. So it is a sort of age dependent. And then after six months, nobody cares about you. I'm just joking, obviously less. That's dangerous at that point.
Most minor respiratory problems can be seen without going to the emergency room
And then the other thing you have to consider is seasonally dependence. You know, we do have rsv season, there's flu season, there used to be all these Covid seasons. Now I don't really know what's happening with COVID It's really not an issue. And if it is, it's very, very minor, so nothing really to worry about it. It really never impacted kids in a negative way anyway. So, you know, these things are sort of age dependent, seasonally dependent on where to go. But understand, most • minor respiratory and, you know, earaches and sore throats and that kind of stuff can kind of be seen by all three, can be seen by your pediatrician, can go to the emergency room, especially if it's a weekend or there's no other place to go. And yes, if it's something simple, you know, can probably be seen at the dreaded urge of care.
If you truly think your child has a broken bone, just go straight to ER
All right, how about injuries? Injuries? Well, obviously, depending on the severity of the injury, if someone's arm's falling off. You need to go to the ER. If you think you have an ankle sprain, then you may be able to go to your pediatrician's, office. Or the urgency now disclaimer. You need to make sure that, you know, both of those places have the ability to do an x ray. Iif you're going there for an injury, or for like, a laceration, you may need to call ahead and see if they do stitches. Again, I'm not being a jerk when I say this, but the vast majority of nurse practitioner training • does not involve procedures, which is crazy, but they're the ones staffing them, urgent care. So now there are some training programs available, like outside of MP school, where you can try to get more practice and get better at, laceration repairs, things like that. So you may need to call ahead and say, hey, do you guys, do, you know, stitch repair and that kind of, you know, suture repair? And same thing with pediatrician's office. Sometimes they'll just send you straight to the ER, and that's fine. You know, we. We do this all day long. So if you need to come in and get that done, then that's fine. So if you think it's something that's like a minor orthopedic injury, like an ankle sprain, wrist sprain, I think it's okay to start off in the office of your pediatrician or even the urgent care, so long as they have the ability to do the x rays. However, understand • • • that we get this all the time, where, like, let's say they think, oh, it's just an ankle spray, and I'll just, I'll just get the x ray, or it's a wrist spray, and I'll get the x ray. What happens is, if it's positive, meaning there's a fracture there, they have no idea what to do with it. So they ended up sending them to the ER anyways, in which case we have to put a splint on. And then for us, it's actually a pretty easy visit because we just look at the x ray. Oh, yeah, okay. You got a colleagues fracture, put you in a, you know, splints, put you in a volar splint, send you on your way to go see ortho. And it's a very quick appointment usually. But understand from a, you know, patient standpoint, it's not very efficient use of time to go all the way to the office of the pediatrician, schedule an appointment, you wait for several hours, and then you get the x ray, and then several hours later, they'll call you and say, hey, it's, you know, it's broken. Now you need to go to the ER because you got to get splinted, etcetera. So I think if you truly think your child has a broken bone, just go straight to the ER. I don't think it's worth going to the office of the pediatrician. If you're like, ah, it's probably just a sprain, rub some dirt on it. Yeah, I think that's probably a good place to start in the office of the pediatrician or the urge of care, if they have the ability to do that.
The most common diagnosis for abdominal pain in children is constipation
All right, how about abdominal pain? Abdominal pain is more challenging. You know, you have to understand, the most common two diagnoses for abdominal pain in the emergency room for children are going to be constipation number one. And number two is Uti. And it's funny to me, I have this conversation with parents literally every shift of my life. Well, they can't. It can't be constipated. He just had a ball movement today or yesterday. Can't be constipated. Yeah, that's not how that works. So, you know, you think about what kids eat. Kids eat what? Pizza, chicken nuggets. Right? Butter noodles, cheese. All these things that are just going to constipate you. They're not getting five servings of fruits and vegetables a day. Right. So, you know, it is absolutely the most common cause. It can be easily seen on an x ray. Sometimes we do an x ray just to kind of make everyone feel better and, you know, sort of identify the fact that there's, like, this huge stool burden, which just means you're full of poop. So those are going to be the most common two causes. Now, we do worry about things, you know, appendicitis, UTI, especially in young girls. Those things we don't want to necessarily miss, obviously. So that's where it gets into, you know, the ER has the ability to do more testing. So, like, look, if you. If your child has very severe abdominal pain and, you know, they're running fevers, you know, fever plus abdominal pain, you know, I think that's where you definitely should go to the emergency room. Now, if your child is chronically constipated and they've been dealing with this and they have this sort of colicky, you know, intermittent episodic abdominal pain, and it's been going on for weeks or months or years, that's where you go to your pediatrician that's not the time to go to the emergency room and certainly not the time to go to the urgicare either. So I think that's where, you know, you have to look kind of the chronicity. Is this acute or is this chronic? If it's an acute abdominal pain, I mean, yes, you can start in the office of your pediatrician, but a lot of times you're going to end up in the ER because we can do blood work, ultrasounds, CAT scans, things like that that you may need. So I think, you know, a little bit of your gut feeling. • • • • Yeah, I cracked myself up. A little bit of a gut feeling there. With your abdominal pain, whether you want to go to the office of your pediatrician versus the emergency room. So I think that's kind of a good place to start. And then jumping off of that, vomiting, diarrhea. Look, if it's minor, it just started today. Then, yeah, you can start off in an urgent care or a pediatrician office. But if this is, like, dangerous, this child has vomited 375 times. Can't keep anything down. You're really concerned that they may need an iv or, God forbid, they're type one diabetic, then, yes, just go to the emergency room. Spoiler alert. However, everyone thinks that something magical happens when we give iv fluids. The American Academy of Pediatrics does recommend that we actually give po meaning, oral fluids first, because it is absorbed faster and much more efficiently, rather than the iv. Everyone thinks the iv is like the cure all. So understand that the first thing that we're probably going to do if it's something that's minor is we're going to give you some zofran or something similar to that to control your nausea. And then we're going to see if we can do what's called a po challenge, meaning we're going to see if we can get you to keep something down, because the vast majority of vomiting, diarrhea is going to be viral. Now, there are plenty of things that cause vomiting and diarrhea beyond the scope of this show. We're not going to get into it, but for the most part, part, they are viral causes. All right, chest pain, shortness of breath. Look, cardiac events are very rare in kids. Chest pain in children's usually going to be something else. It's going to be pulmonary, like asthma or pleurisy or pneumonia, or it's going to be from the GI tract, some indigestion, dyspepsia, gastritis, you know, those kinds of things. You know, occasionally, maybe a stomach ulcer, but that's going to be someone that's usually a little bit older or has some other underlying condition. And then the other thing is musculoskeletal, you know, chest wall pain, something we call costochondritis. Everyone says the words chest pain and freaks out. We get this sometimes, like, in schools and things like that. Oh, my God, the child's having chest pain. Call 911. I've yet to see the child come in with chest pain, from school that is having a heart attack. You know, we do see some dangerous things once in a while. We do see like, a collapsed lung or something like that. But, you know, for the most part, • very rarely when we see chest pain, shortness of breath, does it. Is it really something that's dangerous in the emergency room?
It depends if this is like an acute diagnosis or a chronic headache
All right, so what about headaches? Headaches, migraine headache is somewhat. That's a little bit different. It depends if this is like an acute diagnosis. Is this chronic? My child has migraines, and this has been an ongoing issue. We've seen the neurologist, you know, that kind of stuff. If you need to come to the emergency room and just get relief, that's fine. I mean, that's. If you've ever had a migraine headache, that can be very debilitating. It's very painful. You can't focus. You really can't function on anything, you know? So I think that's, you know, the ER is probably the best place to treat an acute migraine, but if it's like a chronic thing and, you know, well, Junior's been dealing with this headache for several weeks now, and, you know, we've seen the neurologist and, you know, we really just don't know what to do. And, you know, coming to the ER is really not a great place unless the pain is real severe. You're just trying to break the pain. You have to understand that there's diagnostic limitations in the Er like we talked about before, you know, for example, there's a million things that can cause headaches. You know, what are the odds that we're going to find that in the emergency room? You know, blood tests are almost worthless, when it comes to headaches, with the exception of, you know, maybe like a really low sodium. But that's going to be, you know, some, that's not going to be a child. That's going to be an 80 year old on diuretics or whatever. And then, you know, yeah, we do find things, you know, once in a while that are pretty awful. You know, brain tumors and aneurysms and things like that. But that's, that's, that's rare. That's very rare when it comes to your average person, your average human being that, that has a headache. So we had, like, for example, we had a case several months ago that I can't really talk about too specifically, but this, this patient ended up coming to the ER, had a headache, had completely normal vital signs, you know, so they treated him, sent him home, then he came back a couple days later. So I still have the headaches. And now at this point, they appropriately expanded the workup. So they did blood work that was completely, completely normal, the vital signs, completely normal, no fever. And they even did a cat scan completely normal. And then they sent the guy home and then like three weeks later, he bounces into another ER because, you know, the other ER has, you know, they're better. And so they do all the tests. And at this point, there were some changes to the blood work and there was like an elevated white count. Now, at this point, he was running a fever, and so they ended up doing like a lumbar puncture at that time. And they ended up finding this, like, extremely rare, you know, infectious disease cause of headaches that I can't really get into because I don't want to violate any patient privacy laws. But at the end of the day, • this took like a month to sort of sort out. And, you know, of course there's a complaint. And, oh, the ER that saw me the first and the second time, they should, they're. They're dumb and they don't know what they're doing and. Well, no, • first of all, it took a month to get to that point, number one. Number two, we can't just do lumbar punctures and cts on every single human that walks in with a headache. Are you kidding me? Do you have any idea how many people would be harmed by that instead of helped by that? Radiation, needles in the back, etcetera. Like, people have to understand that the disease progression is something that takes time and no one wants that. I wish we had a magic wand that we could just wave as soon as everybody walks through the door. I can't tell you, last time I did a lumbar puncture for a headache, like, that's pretty rare and that's a really tough case. And the fact that they got to a diagnosis, that's great. And by the way, had we done the lumbar puncture four weeks sooner, probably wouldn't have seen anything anyways because it takes time for that to sort of manifest and be able to show up on testing. So understand that there are limitations in healthcare, specifically when discussing headache, I think when it comes to where to go, I think, you know, if it's something that's you need acute relief of pain, or this is an acute headache and you're very concerned about it, then come to the ER. Absolutely. Just understand there are limitations to what we're going to be able to diagnose there. Rashes. Rashes are a little bit difficult. Again, 90% or higher of rashes are completely benign. They're usually due to viruses or something silly, you know, poison ivy, things like that. Nothing that's really dangerous. Less than 10% of rashes are going to be what we considered dangerous in the emergency room. We just have to be able to recognize that, that. So again, I think if you have something simple, you're like, oh, I know what this is. This is poison ivy or whatever. Viral exanthum. Yes, you could potentially go to the urgent care, but even then I would caution against it because we get this all the time. These patients go into the urgent care with poison ivy and they get put on steroids and they get put on the wrong dose. You know, in order to treat • • poison, ivy, you have to be treated for like two weeks. You can have what's called a rebound phenomenon. Like if they, if they give you a five day or a seven day course, or God forbid, a medrol dose pack, you know, you could have something called a rebound phenomenon where you actually get the symptoms kind of get better, and then they get a thousand times worse. And I've seen this in the ER. When patients come back in, they're like, well, I was treated at this urge of care, so again, I would be really cautious about going to the urgent care for that type of a rash. I think your best bet is going to be the pediatrician, especially because they're used to seeing these viral rashes all the time. or the emergency.
The psych system in this country is shattered. I mean, it's beyond shattered
The last thing I want to touch on, obviously, I can't cover every single complaint out there, but,psychiatry, you've heard me say this numerous times on this show before. The psych system in this country is shattered. I mean, it's beyond shattered. For every four patients out there who need a bed, to be hospitalized in the state of Ohio, there's like one available • • • that's not like a joke or anything else. Like, there just truly aren't enough beds that, you know, we don't have psych resources. • • • Very • few facilities have psychiatrists that actually come to the ER to, like, see the patients. So a lot of this is done via telehealth, through mental health professionals and counselors and, you know, just things like that. This is such a time consuming • • resource. Exhaustive visit to the emergency room. And that's not just for the healthcare professionals. I'm referring to the patients and the families as well. I used to work at a facility where a psych patient could be in the ER for seven days in the same room. Like, could you imagine if you weren't crazy before? You'd be crazy then, if you're still in the room for seven days. And, these are people that are, like, not getting showers. They're, they're in these dark rooms half the time, or if they're acutely psychotic or agitated, they're being put down with meds. Like, psych in the ER is very difficult. There's not, we're not psychiatrists where we are trained somewhat in, you know, obviously, the field of psychiatry, but not to the level that these patients need. So my message to you folks out there that do have, especially children that have psychiatric mental health issues and concerns, is learn the hospitals around you. That's the single biggest thing that you can do to help yourself and help your child. If you come to my emergency room, where we have zero psychiatric resources, • • that is going to be more difficult than if you present to life like rainbow babies and children's Hospital or Akron Children's Hospital, • places around you that have mental health resources. And, that's not to say that you always have to be admitted to the hospital, but there's just. There's not that much I can do in the emergency room from a mental health standpoint, specifically for children. And it drives me bonkers that these doctors, these nurse practitioners, urgent cares, et cetera, they're like, oh, well, just go to the ER. Go to the local community ER that has absolutely no psych resources whatsoever, and then these people stay there for hours and hours and hours. Like, you think your ER visit was long? Try coming in with a mental health issue. It is absolutely horrible, especially for children. Very difficult on us, and then obviously, very difficult for the patients and for their families.
ER versus Urgicare versus pediatrician: Where should you take sick child
All right, so to oversimplify, • kind of what we talked about today, we talked about pediatricians, routine healthcare, minor complaints, immunizations, follow ups, or things that have been going on for several weeks, for several months, or for several years. I think that's probably the way to sort of visualize pediatricians, Urgicare understand • • • the limitations of the urge of care. This is going to be something that's very simple. Minor complaints. You need a strep test. You need, do you have to have an x ray for an ankle sprain? So long as they can do that. Do you have a really small laceration check to see that they have that capability. Just understand what you are getting. You are getting a much cheaper visit, • • and you are likely, • not always, but you're likely saving some time, • but you're getting far lower quality of care or someone that has far lower training standards than the emergency room. Again, in the emergency room, if you truly believe your child needs an iv or a procedure like a splint fracture deformity, or if they need advanced workup, lab, ct, ultrasound, you know, imaging and things like that, or if they have something that's potentially dangerous, you know, someone's anaphylactic to peanuts or penicillin or something like that, then yes, the ER is definitely the place. From you, I would never discourage you from coming in, especially with a child. • • Ultimately, if you're not sure, just call your pediatrician or just come to the emergency department. Especially if you call your pediatrician on a Friday afternoon, there's a 100% chance they're going to send you to the ER anyways. I say that jokingly, but also serious. And what are they supposed to do? I mean, they're already, you know, packed for the week. There's no appointments left. Some occasionally have office hours on Saturdays, but for the most part, on weekends, you're kind of on your own. Like I said, the healthcare system is broken. I want to thank you guys for joining me today for where should I take my sick child? Er versus urgicare versus pediatrician. I really appreciate you guys listening and all the reviews. The love on social media. Appreciate it when you guys comment on the posts or share them that I'm very thankful for that. Join me next time. I have a couple of shows in the pipeline. And also look for that show with doctor Dustin Porter. I think you'll find that very amusing as we talk about the very critical thing there with manscaping and how to do it the right way, or I guess, how not to do it the wrong way and end up in the emergency room. Anyways, hope you guys are enjoying your summer. As always, peace, love and happiness to everyone out there. Cheers, guys.
Bình luận