When Should You Go To the Emergency Room?
Have you ever experienced illness, pain, maybe even bleeding, and wondered whether or not you should go to the ER? Everyone has been there at some point or another. Dr. David Cercone discusses how to know when it's time to go to the ER as well as the new freestanding ER at Valley Vista.
Featured Speaker:
David Cercone, DO, FACEP
David Cercone, Doctor of Osteopathic Medicine, is the Medical Director at Centennial Hills Hospital Emergency Department and the new ER at Valley Vista. Dr. Cercone attended medical school at West Virginia School of Osteopathic Medicine. After medical school, he completed his internship at Doctor’s Hospital in Columbus, Ohio and his residency in Emergency Medicine at St. Vincent Medical Center in Toledo, Ohio. Dr. Cercone is a Diplomat of the American Board of Emergency Medicine and a Lifetime Fellow of the American College of Emergency Medicine. Transcription:
When Should You Go To the Emergency Room?
Scott Webb (Host): Have you ever experienced illness, pain, maybe bleeding and wondered whether or not you should go to the ER? I think we've all been there. And joining me today to tell us when we should go to the ER or call 911, is Dr. David Cercone. He's the Medical Director of the Emergency Department at Centennial Hills Hospital. And in addition to helping us to know what rises to the level of an ER, visit, he's going to give us the 411 on the new freestanding, ER, at valley Vista and extension of Centennial Hills hospital.
Scott Webb (Host): welcome to Health Talk with the Valley Health System presented by the Valley. I'm Scott Webb, Doctor, it's so great to have your time. I was just thinking to myself, we've all had injuries. We've all had illnesses and we probably wonder or ask our family members, hey, look at this. Do you think I should go to the emergency room? Some of us are just never quite sure if something rises to the level of going to the ER or the emergency department. So great to have you on answer these questions. Basically the foundational question here. When should we go to the ER?
David Cercone, DO, FACEP (Guest): I found out through the years, that everyone's perception of an emergency is different significantly. I would like to review what symptoms are potentially an emergency and should seek care in the emergency department. Chest pain is probably the most neglected symptoms that could lead to a serious problem or death. It is often ignored until it's too late. Symptoms of a heart attack include not only chest pain, but tightness in the chest, shortness of breath and pain into the jaw, neck or arm. Any of these symptoms lasting more than 10 to 20 minutes should lead to a visit to the emergency department. For every hour of delay in seeking medical attention, you reduce the chances of the heart muscle surviving. If you are indeed having a heart attack, the quicker it is recognized, the better chance of survival and minimizing damage with a procedure known as a stent in the arteries of your heart.
Another group of symptoms, such as facial drooping, weakness in the arms or legs, numbness of the face or extremities and difficulty speaking could mean a significant neurological problem. All of these symptoms may be signs that you are having a stroke. This is especially important to receive care in an ER, as soon as possible when these symptoms start. Time is an important factor as it is with a heart attack and deciding whether a patient is a candidate for a clot busting drug that could potentially prevent severe disability. After a stroke, this drug can be used if a patient is seen within four hours after the onset of symptoms.
Abdominal pain is another symptom that patient often delay care, sudden onset of abdominal pain or pain getting progressively worse after a few hours may indicate a serious underlying problem. Some of the more common diagnoses in people with a abdominal pain include appendicitis, diverticulitis, pancreatitis, and gallbladder disease. If the symptoms go untreated in some of these illnesses, it can lead to more serious problems such as a perforation of your bowel that may lead to life threatening infection.
Confusion, fever, difficulty urinating are also symptoms that should be evaluated rather quickly, that patients should consider a visit to the ER. Urinary tract infections are easily treated if diagnosed early. Frequent urination, burning with urination, back pain could all be symptoms of a urinary tract infection. If left untreated, it can lead to a more serious problem. Especially in elderly patients urinary tract infections can sometimes present as just confusion, particularly in patients with other health problems.
Host: Doctor it's great to have you on because there are obviously a lot of reasons why folks would need ER. Unfortunately, I'm sure there are others, right?
Dr. Cercone: Yes. Another reason for someone seeking health care in the emergency department is for vomiting blood or blood in the stool. These symptoms could represent a bleeding stomach ulcer, or bleeding from the intestines. Some patients who delay getting seen may start to experience lightheadedness, rapid heart rate, which may indicate a more serious bleeding problem and may need a blood transfusion.
Shortness of breath is another symptom that should lead to somebody to visit an emergency department. During the last two years of the pandemic it is probably one of the leading causes for people to come to the ER. There are a number of underlying causes of shortness of breath, including asthma, pneumonia, congestive heart failure, pulmonary embolus, and a heart attack. Any of these diseases could be potentially life-threatening if not treated timely.
And then some of the other things people should consider visiting an emergency department include choking on food, difficulty swallowing, head injuries, particularly if there was a loss of consciousness with a head injury, injuries to the neck or spine, particularly if you have pain or weakness in your extremities, electrical shocks, severe burns. Particularly burns of the face. Seizure disorders in people that have not had a history of seizures, people passing out or a syncopal type episode may mean that you had a cardiac arrhythmia where your heart's beating irregular causing your blood pressure to drop. Severe headaches, especially if their sudden onset headaches may be indicative of some type of bleeding in the brain.
Fractures, obviously of the extremities, anywhere in the body should be evaluated. Lacerations, allergic reactions, particularly if it involves some shortness of breath associated with this. Anyone with a high fever with headaches or neck pain should be evaluated. It may be an indication that they have meningitis. Overdoses of drugs or alcohol, are a particularly common thing that patients need to be evaluated in the emergency department. Particularly with some of the over-the-counter medications, such as Tylenol and aspirin, they can lead to potentially serious problems with the organs in the body, particularly the liver. Obviously suicidal thoughts are something that patients should be evaluated, should speak to someone and make sure that they receive some type of followup care.
Again, as I said earlier, everybody's perception of an emergency is different. If you are unsure, your best bet is to seek care in the emergency department and let the emergency physician do their job.
Host: Yeah, I think that's a good takeaway, right? Time is of the essence so you were talking about stroke and heart attack. So time is brain. Time is heart, and if we're not sure, probably best to get ourselves there, call 911. However we get there, obviously make good decisions about that, about our transportation, but really gives us a sense for emergency room or emergency department docs and nurses, just how versatile you all have to be, because that's a long list of reasons why people might come to see all of you. And I'm sure a lot of people wonder, well, if I go to the ER, then I'm going to be admitted to the hospital and I don't have time for all that. Is that the case there? Most people just, almost always, if they're in the ER, they're probably going to be admitted?
Dr. Cercone: No dope. Probably 75% of the patients we've seen in emergency department are discharged home. We evaluate these patients. We try to do as possible treating people safely as an outpatient. So no, the majority of people that do come to the emergency department are discharged home with a diagnosis and treatment.
Host: That's good to know. I think there's just a, we talk about perception versus reality just because something is serious enough to go to the ER or the ED doesn't mean that the hospital really wants you to stay there. They'd like to be able to treat you and get you on your way and move on to the next patient and help more people.
So that's awesome. Let's talk a little bit about in transition to sort of change of the paradigm in medicine, right? It's always been if we're sick or we're injured, we come to all of you, but bringing the medicine and the care out into the communities is as a newer trend as is these freestanding emergency departments.
So I want you to tell us a little bit about the thinking behind the freestanding EDs, and also tell us about the newest one, Valley Vista.
Dr. Cercone: Yes. Our newest freestanding emergency department is in was Las Vegas. It's in north Las Vegas. It's the ER at Valley Vista. This was an opportunity for Centennial Hills Hospital to bring excellent emergency care right in the local community. It is staffed by physicians,
registered nurses and technicians, including lab and x-ray. The facility is nine bed facility. We have the capability of receiving ambulances and we do on a daily basis. It provides us the ability to see patients in their local community without having to be seen in an emergency department at a hospital.
Host: Yeah, it's a really cool initiative. And I've been hearing about this and things have been trending this way, but I'm sure folks maybe wonder, well, okay, sure it's an ER, but it's not connected to the hospital, so they probably can't do everything that they could do with the one by the hospital. So maybe I should just go there. So maybe you could put their fears aside that it's a fully functioning, fully capable ED.
Dr. Cercone: Yes, Yes, we have all the capabilities in the freestanding emergency department that any emergency room would have We have advanced imaging services, including CT, ultrasound and x-ray, onsite laboratory.
David Cercone, DO, FACEP (Guest): We have the capabilities to take care of a cold and to stabilize care for cardiac arrest and stroke patients.
in the process. If you do need to be admitted to the hospital, we can arrange for transfer to your hospital of choice
to a patient's bed.
Dr. Cercone: bypassing the emergency department and in the hospital, we also have a network of specialists across all specialties to provide follow-up care for our patients that were seen in our ER at Valley Vista.
Host: Yeah. And is the freestanding ED at Valley Vista the same or different than urgent care? Maybe you can explain the differences between those. Is it just a matter of semantics or is there an actual difference?
Dr. Cercone: No, there is an actual difference. Typical urgent care does not have the advanced imaging technology, does not have the advanced staffing that we have in our department. They do not receive ambulances like our freestanding EDs do and they're just overall, we have more capabilities than urgent cares would have in the community.
Host: Yeah, I see what you mean. And the the costs of medical care, obviously are on everybody's minds, right? So is it cheaper or less expensive to go to the ED at Valley Vista than if we were to go to the ED or emergency room at the hospital?
Dr. Cercone: Now the ER Valley Visita is an emergency room. Therefore, the cost is the same as the hospital ER.
Host: Okay. Right. So you're not going to necessarily save any money, but because the one, the ED at Valley Vista may be closer to you and fully functioning, and transportation's available if you need to go to the hospital, there's a lot of good reasons to go there. And I'm assuming then, because it is a real ED it's even though it's not attached to the hospital. So I'm assuming then health insurance covers it. There's no questions there.
Dr. Cercone: Absolutely. The ER at Valley Vista accepts most major insurances, including Medicare, Medicaid, managed Medicare and Medicaid. And most HMO, commercial insurance products. We encourage you to check with your insurance provider to verify which facilities are in your network or call our billing office. And we'll be happy to verify for you.
Host: Absolutely. But if you need care, obviously the important thing is to get somewhere, get to the ED at Valley Vista or the hospital, whichever, maybe some folks are going to wonder is the Valley Vista ED a place to bring babies?
Dr. Cercone: Yes. We have the capability to see all age groups, including infants, babies and all the way to the elderly patients. So we can treat all adult and pediatric patients in the ER at Valey Vista.
Host: That's awesome, you know, from pediatric to elderly, and fully functioning, just like we were at the hospital ED. So very cool. Maybe you could tell us where it's actually located.
Dr. Cercone: It's located off of 215 on the northeast corner of Decatur Boulevard and Elkhorn Road, it is just north to the DMV off of Decatur Boulevard.
Host: That's great. Well, it's been great to get to know you a little bit here, doctor, and hear your expertise on both emergency rooms and emergency departments. When we should go and Valley Vista, what would be your takeaways today?
Dr. Cercone: Well, my takeaways is to tell the community that we are there for you in the emergency department, to not ignore a lot of symptoms, if you do indeed, feel uncomfortable with what's going on, come to the Emergency Department. Again, we have multiple facilities across the Las Vegas valley and with our new facility ER at Valley Vista, we're now bringing patient care, emergency care right to your community.
Host: Yeah, definitely are. And of course we've heard so many stories and you would know being on the front lines, people delaying care during COVID right. And as the symptoms that you were talking about, right? Symptoms of stroke, symptoms of heart attack, and time is of the essence. And now with this Valley Vista ED, like right there in the community, doing everything you can to meet patients where they are and provide the best care you can. So, thanks so much and you stay well.
Dr. Cercone: Thank you very much.
Host: And for more information, visit valleyhealthsystemlv.com. And if you found this podcast to be helpful, please share it on your social channels. Be sure to check out the entire podcast library for additional topics of interest. Thanks again for listening to this episode of Health Talk.
I'm Scott Webb. Stay well and we'll talk again next time.
Physicians are independent practitioners who are not employees or agents of the Valley Health System. The system shall not be liable for actions or treatments provided by physicians.
When Should You Go To the Emergency Room?
Scott Webb (Host): Have you ever experienced illness, pain, maybe bleeding and wondered whether or not you should go to the ER? I think we've all been there. And joining me today to tell us when we should go to the ER or call 911, is Dr. David Cercone. He's the Medical Director of the Emergency Department at Centennial Hills Hospital. And in addition to helping us to know what rises to the level of an ER, visit, he's going to give us the 411 on the new freestanding, ER, at valley Vista and extension of Centennial Hills hospital.
Scott Webb (Host): welcome to Health Talk with the Valley Health System presented by the Valley. I'm Scott Webb, Doctor, it's so great to have your time. I was just thinking to myself, we've all had injuries. We've all had illnesses and we probably wonder or ask our family members, hey, look at this. Do you think I should go to the emergency room? Some of us are just never quite sure if something rises to the level of going to the ER or the emergency department. So great to have you on answer these questions. Basically the foundational question here. When should we go to the ER?
David Cercone, DO, FACEP (Guest): I found out through the years, that everyone's perception of an emergency is different significantly. I would like to review what symptoms are potentially an emergency and should seek care in the emergency department. Chest pain is probably the most neglected symptoms that could lead to a serious problem or death. It is often ignored until it's too late. Symptoms of a heart attack include not only chest pain, but tightness in the chest, shortness of breath and pain into the jaw, neck or arm. Any of these symptoms lasting more than 10 to 20 minutes should lead to a visit to the emergency department. For every hour of delay in seeking medical attention, you reduce the chances of the heart muscle surviving. If you are indeed having a heart attack, the quicker it is recognized, the better chance of survival and minimizing damage with a procedure known as a stent in the arteries of your heart.
Another group of symptoms, such as facial drooping, weakness in the arms or legs, numbness of the face or extremities and difficulty speaking could mean a significant neurological problem. All of these symptoms may be signs that you are having a stroke. This is especially important to receive care in an ER, as soon as possible when these symptoms start. Time is an important factor as it is with a heart attack and deciding whether a patient is a candidate for a clot busting drug that could potentially prevent severe disability. After a stroke, this drug can be used if a patient is seen within four hours after the onset of symptoms.
Abdominal pain is another symptom that patient often delay care, sudden onset of abdominal pain or pain getting progressively worse after a few hours may indicate a serious underlying problem. Some of the more common diagnoses in people with a abdominal pain include appendicitis, diverticulitis, pancreatitis, and gallbladder disease. If the symptoms go untreated in some of these illnesses, it can lead to more serious problems such as a perforation of your bowel that may lead to life threatening infection.
Confusion, fever, difficulty urinating are also symptoms that should be evaluated rather quickly, that patients should consider a visit to the ER. Urinary tract infections are easily treated if diagnosed early. Frequent urination, burning with urination, back pain could all be symptoms of a urinary tract infection. If left untreated, it can lead to a more serious problem. Especially in elderly patients urinary tract infections can sometimes present as just confusion, particularly in patients with other health problems.
Host: Doctor it's great to have you on because there are obviously a lot of reasons why folks would need ER. Unfortunately, I'm sure there are others, right?
Dr. Cercone: Yes. Another reason for someone seeking health care in the emergency department is for vomiting blood or blood in the stool. These symptoms could represent a bleeding stomach ulcer, or bleeding from the intestines. Some patients who delay getting seen may start to experience lightheadedness, rapid heart rate, which may indicate a more serious bleeding problem and may need a blood transfusion.
Shortness of breath is another symptom that should lead to somebody to visit an emergency department. During the last two years of the pandemic it is probably one of the leading causes for people to come to the ER. There are a number of underlying causes of shortness of breath, including asthma, pneumonia, congestive heart failure, pulmonary embolus, and a heart attack. Any of these diseases could be potentially life-threatening if not treated timely.
And then some of the other things people should consider visiting an emergency department include choking on food, difficulty swallowing, head injuries, particularly if there was a loss of consciousness with a head injury, injuries to the neck or spine, particularly if you have pain or weakness in your extremities, electrical shocks, severe burns. Particularly burns of the face. Seizure disorders in people that have not had a history of seizures, people passing out or a syncopal type episode may mean that you had a cardiac arrhythmia where your heart's beating irregular causing your blood pressure to drop. Severe headaches, especially if their sudden onset headaches may be indicative of some type of bleeding in the brain.
Fractures, obviously of the extremities, anywhere in the body should be evaluated. Lacerations, allergic reactions, particularly if it involves some shortness of breath associated with this. Anyone with a high fever with headaches or neck pain should be evaluated. It may be an indication that they have meningitis. Overdoses of drugs or alcohol, are a particularly common thing that patients need to be evaluated in the emergency department. Particularly with some of the over-the-counter medications, such as Tylenol and aspirin, they can lead to potentially serious problems with the organs in the body, particularly the liver. Obviously suicidal thoughts are something that patients should be evaluated, should speak to someone and make sure that they receive some type of followup care.
Again, as I said earlier, everybody's perception of an emergency is different. If you are unsure, your best bet is to seek care in the emergency department and let the emergency physician do their job.
Host: Yeah, I think that's a good takeaway, right? Time is of the essence so you were talking about stroke and heart attack. So time is brain. Time is heart, and if we're not sure, probably best to get ourselves there, call 911. However we get there, obviously make good decisions about that, about our transportation, but really gives us a sense for emergency room or emergency department docs and nurses, just how versatile you all have to be, because that's a long list of reasons why people might come to see all of you. And I'm sure a lot of people wonder, well, if I go to the ER, then I'm going to be admitted to the hospital and I don't have time for all that. Is that the case there? Most people just, almost always, if they're in the ER, they're probably going to be admitted?
Dr. Cercone: No dope. Probably 75% of the patients we've seen in emergency department are discharged home. We evaluate these patients. We try to do as possible treating people safely as an outpatient. So no, the majority of people that do come to the emergency department are discharged home with a diagnosis and treatment.
Host: That's good to know. I think there's just a, we talk about perception versus reality just because something is serious enough to go to the ER or the ED doesn't mean that the hospital really wants you to stay there. They'd like to be able to treat you and get you on your way and move on to the next patient and help more people.
So that's awesome. Let's talk a little bit about in transition to sort of change of the paradigm in medicine, right? It's always been if we're sick or we're injured, we come to all of you, but bringing the medicine and the care out into the communities is as a newer trend as is these freestanding emergency departments.
So I want you to tell us a little bit about the thinking behind the freestanding EDs, and also tell us about the newest one, Valley Vista.
Dr. Cercone: Yes. Our newest freestanding emergency department is in was Las Vegas. It's in north Las Vegas. It's the ER at Valley Vista. This was an opportunity for Centennial Hills Hospital to bring excellent emergency care right in the local community. It is staffed by physicians,
registered nurses and technicians, including lab and x-ray. The facility is nine bed facility. We have the capability of receiving ambulances and we do on a daily basis. It provides us the ability to see patients in their local community without having to be seen in an emergency department at a hospital.
Host: Yeah, it's a really cool initiative. And I've been hearing about this and things have been trending this way, but I'm sure folks maybe wonder, well, okay, sure it's an ER, but it's not connected to the hospital, so they probably can't do everything that they could do with the one by the hospital. So maybe I should just go there. So maybe you could put their fears aside that it's a fully functioning, fully capable ED.
Dr. Cercone: Yes, Yes, we have all the capabilities in the freestanding emergency department that any emergency room would have We have advanced imaging services, including CT, ultrasound and x-ray, onsite laboratory.
David Cercone, DO, FACEP (Guest): We have the capabilities to take care of a cold and to stabilize care for cardiac arrest and stroke patients.
in the process. If you do need to be admitted to the hospital, we can arrange for transfer to your hospital of choice
to a patient's bed.
Dr. Cercone: bypassing the emergency department and in the hospital, we also have a network of specialists across all specialties to provide follow-up care for our patients that were seen in our ER at Valley Vista.
Host: Yeah. And is the freestanding ED at Valley Vista the same or different than urgent care? Maybe you can explain the differences between those. Is it just a matter of semantics or is there an actual difference?
Dr. Cercone: No, there is an actual difference. Typical urgent care does not have the advanced imaging technology, does not have the advanced staffing that we have in our department. They do not receive ambulances like our freestanding EDs do and they're just overall, we have more capabilities than urgent cares would have in the community.
Host: Yeah, I see what you mean. And the the costs of medical care, obviously are on everybody's minds, right? So is it cheaper or less expensive to go to the ED at Valley Vista than if we were to go to the ED or emergency room at the hospital?
Dr. Cercone: Now the ER Valley Visita is an emergency room. Therefore, the cost is the same as the hospital ER.
Host: Okay. Right. So you're not going to necessarily save any money, but because the one, the ED at Valley Vista may be closer to you and fully functioning, and transportation's available if you need to go to the hospital, there's a lot of good reasons to go there. And I'm assuming then, because it is a real ED it's even though it's not attached to the hospital. So I'm assuming then health insurance covers it. There's no questions there.
Dr. Cercone: Absolutely. The ER at Valley Vista accepts most major insurances, including Medicare, Medicaid, managed Medicare and Medicaid. And most HMO, commercial insurance products. We encourage you to check with your insurance provider to verify which facilities are in your network or call our billing office. And we'll be happy to verify for you.
Host: Absolutely. But if you need care, obviously the important thing is to get somewhere, get to the ED at Valley Vista or the hospital, whichever, maybe some folks are going to wonder is the Valley Vista ED a place to bring babies?
Dr. Cercone: Yes. We have the capability to see all age groups, including infants, babies and all the way to the elderly patients. So we can treat all adult and pediatric patients in the ER at Valey Vista.
Host: That's awesome, you know, from pediatric to elderly, and fully functioning, just like we were at the hospital ED. So very cool. Maybe you could tell us where it's actually located.
Dr. Cercone: It's located off of 215 on the northeast corner of Decatur Boulevard and Elkhorn Road, it is just north to the DMV off of Decatur Boulevard.
Host: That's great. Well, it's been great to get to know you a little bit here, doctor, and hear your expertise on both emergency rooms and emergency departments. When we should go and Valley Vista, what would be your takeaways today?
Dr. Cercone: Well, my takeaways is to tell the community that we are there for you in the emergency department, to not ignore a lot of symptoms, if you do indeed, feel uncomfortable with what's going on, come to the Emergency Department. Again, we have multiple facilities across the Las Vegas valley and with our new facility ER at Valley Vista, we're now bringing patient care, emergency care right to your community.
Host: Yeah, definitely are. And of course we've heard so many stories and you would know being on the front lines, people delaying care during COVID right. And as the symptoms that you were talking about, right? Symptoms of stroke, symptoms of heart attack, and time is of the essence. And now with this Valley Vista ED, like right there in the community, doing everything you can to meet patients where they are and provide the best care you can. So, thanks so much and you stay well.
Dr. Cercone: Thank you very much.
Host: And for more information, visit valleyhealthsystemlv.com. And if you found this podcast to be helpful, please share it on your social channels. Be sure to check out the entire podcast library for additional topics of interest. Thanks again for listening to this episode of Health Talk.
I'm Scott Webb. Stay well and we'll talk again next time.
Physicians are independent practitioners who are not employees or agents of the Valley Health System. The system shall not be liable for actions or treatments provided by physicians.