Avoid Unnecessary Pediatric Trips to the ER – Advice from Georgia PAs

The Georgia Association of Physician Assistants wants to help parents identify the symptoms of a true pediatric medical emergency, and, in the process, help them avoid an unnecessary trip to an overcrowded emergency room.

Online PR News – 09-July-2010 – – (Atlanta, GA) - It's the middle of the night and your baby wakes up, crying. She feels hot, and when you check her temperature, it measures 101. You call your physician's office, and hear a recording stating that if you have an emergency, to proceed to the emergency room. But is this an emergency? Or, your 15-year-old son returns from the neighborhood pool with a bad sunburn. You slather on aloe but later that night he starts shivering and feels nauseated. What do you do?

Almost every parent has a story like this. And while each case is unlike any other, parents aren't often able to determine whether the child's symptoms warrant a trip to the emergency room. True medical emergencies such as severe bleeding, difficulty breathing, choking, broken bones, seizure or coma require immediate medical attention. But sometimes the symptoms do not present a clear picture of the severity of the problem. How high does a fever need to get before it's an emergency? Is it a sunburn, or sun poisoning?

The Georgia Association of Physician Assistants wants to help parents identify the symptoms of a true pediatric medical emergency, and, in the process, help them avoid an unnecessary trip to an overcrowded emergency room.

GAPA suggests first developing an emergency plan.

“Make sure you have a list of numbers handy in case of an emergency,” said Ben Taylor, PhD, PA-C. Taylor is the public education chair for the Georgia Association of Physician Assistants and works in multiple emergency departments in the Georgia/South Carolina area. “The list should include numbers for the primary provider; emergency medical services - in most places this is 911; the poison control center (800-222-1222); hospital emergency room; police and fire; Ask-A-Nurse, and neighbors or relatives.”

Taylor also suggests talking with your child’s primary provider about their practice's after-hours procedures, and any follow-up steps that may be necessary after an emergency room visit. Plus, learn about other resources that may be available during after-hours emergencies.

“If there is an urgent care center nearby, ask your provider if it is an after-hours option for your child. Learn what services are provided, and when to choose an urgent care center over an emergency room,” added Taylor. “Make a list of your children's medical conditions, known allergies, and medications they are taking, as well as insurance information.

“You can also learn how to evaluate common pediatric symptoms. GAPA members strive to help patients learn as much as they can about getting and staying healthy. So, just ask a PA about symptoms your child might experience. We’ll be happy to discuss recommendations with you,” said Taylor.

Common pediatric symptoms might include:

3-month-old or younger infants with a temperature of 100.4 degrees F (38 degrees C) or higher should receive immediate medical attention. Even a slight fever can be a sign of a potentially serious infection in very young infants. For older children, seek medical attention for a temperature higher than 102.2 degrees F (39 degrees C). For older kids, take behavior and activity level into account. Watching how your child behaves will give you a pretty good idea of whether a minor illness is the cause or if your child should be seen by a healthcare professional. Usually acetaminophen is the fever reducer that pediatricians recommend. Aspirin is avoided due to the possibility of a rare but serious problem called Reye's Syndrome.*

A mild stomachache isn't usually a cause for concern. It might be caused by constipation and can often be remedied with healthy eating and exercise habits. A condition called irritable bowel syndrome (IBS) can occur when kids are stressed or eat certain trigger foods, which often are fatty or spicy. A child with IBS may have either constipation or diarrhea, as well as stomach pain or gas. Appendicitis (inflammation of the appendix) requires immediate medical attention. The symptoms of appendicitis start with a mild fever and pain around the bellybutton, and can be accompanied by vomiting, diarrhea, or constipation. The stomach pain usually worsens and moves to the lower right side of the belly. Call your doctor immediately if you suspect that your child has appendicitis. The earlier it's caught, the easier it will be to treat.*

A broken (fractured) bone requires emergency care, as well as injuries involving the neck or spine. Suspect a possible broken bone if your child heard or felt a bone snap, if your child has difficulty moving the injured part, or if the injured part moves in an unnatural way, appears deformed, or is very painful to the touch. A sprain occurs when the ligaments, which hold bones together, are overstretched and partially torn. Simply overstretching any part of the musculature is called a strain. Sprains and strains generally cause swelling and pain, and there may be bruises around the injured area. Most sprains, after proper medical evaluation, can be treated at home.

Remember RICE for Sprains and Strains (Rest, ice, compression, and elevation.
• Rest the injured part of the body.
• Apply ice packs or cold compresses for up to 10 or 15 minutes at a time every few hours for the first 2 days to prevent swelling.
• Wearing an elastic compression bandage (such as an ACE bandage) for at least two days will reduce swelling.
• Keep the injured part elevated above the level of the heart as much as possible to reduce swelling.
Do not apply heat in any form for at least 24 hours. Heat increases swelling and pain. Your child's doctor may recommend an over-the-counter pain reliever such as acetaminophen or ibuprofen.

For severe burns, seek emergency medical services immediately. For mild to moderate burns, submerse in cool water, or apply cold compresses immediately after being burned to help relieve pain and swelling. Remove clothes, shoes, and jewelry, from the burned area. Do not apply ointments or ice directly to the skin. Always wrap the ice in a towel. Allow blisters to break on their own. Dab antibiotic ointment on open blisters and cover with a dry dressing. Take acetaminophen for pain, and take sips of cool water. Consult a doctor if sunburn affects an infant younger than one year of age or if these symptoms are present: fever, fluid-filled blisters, and severe pain. Apply moisturizing lotion to treat mild sunburn.

“When an emergency arises and a trip to the ER is needed, it can be a stressful experience,” Taylor added. “To help the visit go more smoothly, remember to make sure to bring important documents such as insurance cards and identification, and to follow up with your primary care provider at the next available appointment within 2-3 days.”

It is the mission of the Georgia Association of Physician Assistants to promote high quality, cost-effective, accessible health care as part of a physician-directed PA/physician team in Georgia. To learn more health tips or how PAs make health care more affordable and accessible in Georgia, please visit www.GAPA.net and click on “Patients.”


*Guidelines from KidsHealth.org

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