Each year over one-half million people die because they don’t get to their doctor or to an emergency room soon enough with their medical problems. Delay is deadly and for a heart attack or stroke, there’s a “golden hour” in which care must be given to be successful. On NBC’s “Today” show, ER specialist, Dr. Kevin Soden, explains how “Seconds Can Save Lives” and discusses seven important signs and symptoms requiring immediate action to protect your health and that of your loved ones.
WHAT DOES THE “GOLDEN HOUR” MEAN REGARDING MEDICAL CARE?
How soon a person seeks medical care can mean the difference between life and death or between a relatively easy cure and a highly dangerous situation. The “golden hour” of medical care is not just an hour but refers to that critical time period in which medical treatment must occur in order to avoid serious medical problems. It’s really the sooner, the better. For instance, in a heart attack or stroke, we have to unblock the arteries to the heart or brain to prevent damage within three hours of your symptoms first occurring. Giving medicine after this time does no good so we need to learn to recognize problems early and then take action. Right now, about 60 percent of heart attacks don’t get to medical care within the golden three hours. This is why so many people are dying unnecessarily.
WHY DON’T PEOPLE GET TO A HOSPITAL SOON ENOUGH?
There are many reasons why patients aren’t getting to the hospital early enough to reap the benefits of therapy. First, people don’t recognize when they need to take action. They just don’t know the warning signs when something is seriously wrong. Most people believe that their symptoms would resolve spontaneously. Either they haven’t paid attention or their doctors haven’t warned them. Second, people don’t want to inconvenience others especially if it’s the middle of the night. Women are often worse than men because they’re the caretakers of the family so often. They try to put everything in order before looking out for themselves. Finally, people don’t want to look foolish by rushing to the ER if nothing is seriously wrong.
ISN’T ANYONE DOING ANYTHING ABOUT THIS?
Yes, a number of groups are trying to educate the public on the key warning signs. It’s one of the reasons why the American Heart Association began it’s Act in Time campaign a couple of years ago. Now, the American College of Emergency Physicians or ACEP is promoting its Seconds Save Lives educational efforts. There is no group who knows better than ER doctors the importance of getting proper care as early as possible. ACEP wants people to recognize a problem and then act.
GETTING TO THE ER OR TO A PERSON’S DOCTOR EARLY ISN’T JUST IMPORTANT IN HEART ATTACKS OR STROKES, IS IT?
Absolutely right. There are many other conditions that require both early diagnosis and early treatment. We sometime refer to these as Diagnostic Imperatives because missing these diagnoses or not getting them treated early enough can cause major problems for a patient. Let me give you some practical examples. A child with prolonged abdominal pain doesn’t see the doctor soon enough so their appendix ruptures and causes severe abdominal infection. A woman suddenly develops difficulty breathing that doesn’t go away quickly. The blood clot that went to her lung from her legs gets worse so that she almost dies. There is some good news: We are all given very clear warning signs or symptoms when we need to take action. The key is recognizing them.
WHAT ARE THE LIFE-THREATENING WARNING SIGNS THAT I NEED TO RECOGNIZE?
The first is sudden or severe pain that doesn’t quickly go away. This is especially true with headaches. If you develop a headache that is the worst you’ve ever had, it could mean bleeding inside your head from a ruptured artery. It’s more common in women than men and is often neglected. Now we don’t want every person with a migraine running to the ER. It should only be for sudden severe pain that’s well beyond anything that you’ve ever had before.
The same is also true with abdominal or stomach pain. If the pain is sudden or doesn’t go away or gets worse, get to the ER. In women, it could mean an ectopic pregnancy, appendicitis or a hole in your intestine from a diverticuli if you are older. All of these are true emergencies and I can’t tell you how many times I’ve seen who’ve waited too long and gotten in trouble.
And of course, don’t forget chest pain that doesn’t go away. For women, the sign of a heart attack might be in the chest or it could be in the abdomen or back. Delay is deadly. Be suspicious and then take action.
The second severe warning sign is difficulty breathing or unusual shortness of breath. This can mean a blood clot to the lung or a hole in the lung. It can also indicate heart failure in older people. Obviously, if you’re a smoker or out of shape physically, then you may get short of breath just doing normal things. We’re talking about breathing problems that are unusual for you.
WHAT ARE SOME OTHER WARNING SIGNS?
Any change in mental status.
If someone suddenly becomes confused, disoriented, or can’t be aroused, they need to get to the ER right away. A change in your mental condition or thinking can indicate a stroke, an infection, heat stroke or any number of serious medical problems and shouldn’t be ignored.
WHAT ABOUT THE WARNING SIGNS FOR MENINGITIS? PEOPLE HEAR STORIES ABOUT THIS.
A headache with a stiff neck or fever could be a warning sign of meningitis, an infection of the lining of the brain.
If you can’t touch your chin to your chest and you’ve got a headache and fever, you need to get checked right away.
HOW ABOUT BLEEDING? ISN’T THAT A WARNING SIGN?
Coughing or vomiting blood is a warning sign.
I don’t mean the little bit of blood we sometimes cough up when we have a cold, but I mean a good handful of blood. Vomiting blood can indicate internal bleeding as can black or tarry looking bowel movements, even a single episode.
Also, uncontrolled bleeding of any kind is an emergency. Too often people with nosebleeds wait too long before seeking help. Another type of bleeding that requires medical care is vaginal bleeding after menopause. In women, this can be a sign of uterine cancer and must be taken very seriously.
Finally, unexplained weight loss and/or loss of appetite. Obviously, if you are trying to lose weight, that’s not a problem, but losing weight for no good reason can indicate a serious illness like diabetes or cancer. If you also begin to gain weight without changing your exercise or eating habits, it can mean fluid accumulation in your abdomen and can be a warning sign for ovarian cancer.
WHAT ABOUT THE WARNING SIGNS FOR A STROKE?
Strokes are a true emergency requiring immediate care and we know that too many people wait before seeking help. If you have paralysis of one of your arms or legs, slurred speech, drooping of one side of your face or confusion, don’t wait to see if it stops, get to an ER to be evaluated.
OK, YOU’VE NOTICED ONE OF THESE IMPORTANT WARNING SIGNS, DOES IT MATTER WHAT HOSPITAL YOU GO TO?
You bet it does. Not all hospitals have the equipment or staff to handle true emergencies like some of these. Make sure that your local hospital has emergency medicine trained physicians and that they have the backup they need to treat strokes, heart attacks and other emergencies available 24 hours a day. Check into this before you have an emergency so you don’t waste precious time in the wrong hospital and be sure when you get to the hospital tell them why you are there and what you think might be wrong so you don’t sit in a waiting room unnecessarily.
Dr. Kevin Soden is an emergency room physician at Carolinas Medical Center in Charlotte, North Carolina and the author of “The Art of Medicine: What Every Doctor and Patient Should Know.”
For more information you can visit the American College of Emergency Physicians Web site at: www.acep.org.
If you’d like the pamphlet, Seconds Save Lives, from ACEP send a self-addressed, stamped envelope to: