Time for ER? Don't ignore these symptoms

To go to the ER or not. It’s a question you’ve likely debated.

It could be nothing. But what if it’s not nothing? Could it be serious? Is it the start of something? Nah, I’ll see how it feels tomorrow.

Sometimes, though, it’s best not to delay, as your better-safe-than-sorry gene kicks your common sense into action.

Miguel L. Terrazas III, M.D., has been an ER physician at The Hospitals of Providence Memorial Campus, Sierra Campus and East Campus. He also has stints with Las Palmas Del Sol Healthcare and a current one with Sun City Emergency Room on his résumé.

Let’s skip past obvious trauma injuries and conditions and look at symptoms more likely to be ignored that could have serious, even lethal, consequences. Terrazas lists four problem areas that are ER-worthy:

Abdominal pain

Roughly a third of the ER patients he sees come in complaining of abdominal pain. Sometimes that pain can mean nothing – constipation, something you ate, indigestion – but sometimes it can mean something more serious, like appendicitis or a gall bladder problem, the latter very common in El Paso, he said.

“When you should start to worry is if you have constant abdominal pain that isn’t going away, for two to four hours, let’s say,” he said. “If the pain comes and goes, it’s probably less likely to be serious.”

Also, consider the severity of your abdominal pain – does it hit you hard, is it an unheard-of kind of pain? Is it sharp, burning, throbbing? Do you have fever with the pain?

If it’s abdominal pain and fever, but nothing else, such as a runny nose for example, get it looked at.

He also recommended visiting an ER if you can’t keep food down.

Chest discomfort

Some gastric abdominal pain can be a sign of a cardiac-related problem, more so in women than in men, Terrazas pointed out, so he thinks minutes, not hours, count here. Don’t wait hours to get to an ER.

For all of us, though, trouble breathing or sudden-onset chest pain definitely are signs that an ER visit makes sense.

As does age. For people age 50 and up, chest discomfort can be more likely to be cardiac-related. As Terrazas admitted, “If an age 80-plus patients shows up with chest pain, I’m gonna be worried.”


Doctors still can have problems easily identifying an actual stroke, Terrazas said, because stroke symptoms often are painless.

Slurred speech, facial droop on one side or a crooked face, and arm or leg weakness on the same side of the body can be signs of stroke. So can sudden-onset things like drooling, or if your words suddenly aren’t making sense to others.

“It’s ‘time treatment,’” Terrazas added. “Ideally, that would be under three hours from the first symptoms. And the clock starts from the last time we saw them normal. Time is brain.”

Stroke treatment in an ER involves getting blood flow back to the part of the brain that’s been hit.

Headaches can be a stroke sign, though he noted most headaches are treatable at home. But for a headache that’s out of the normal pattern, such as loss of consciousness or a headache with confusion, go to the ER.

Deep Vein Thrombosis: DVT

Blood clots. Don’t fool with these. They often hit in the big veins in the calf or thigh, not usually in your arm.

“Clots down there are bigger, and they’re all connected,” Terrazas said. “We worry about a piece of the clot breaking off and then getting into the lungs and getting stuck.”

Blood clots in the leg can fool people, as the pain often is mild at first and you might suspect merely a pulled muscle. But with a DVT, the mild pain doesn’t go away, and swelling follows.

Jack Butler, M.D., is an ER physician at the Texas Tech University Health Sciences Center in El Paso. He echoed what Terrazas said, and added that when it comes to blood clots, DVT doesn’t play favorites.

“It can happen at young ages, even to people in their 20s or 30s,” he said, noting as well that genetics sometimes are a factor.

“We call it ‘provoked,’ like after hip surgery, or ‘unprovoked,’ which is the unlucky group of people where it just happens, often for no apparent reason,” he said, citing examples of common causes of blood clots.

Anybody who has sat for long periods of time may be increasing their risk of a blood clot forming. So, long car rides, long plane trips, even following minor surgery sometimes – this is why physicians recommend we move around as much as possible in those situations.

Three to six weeks of treatment with blood thinners often is needed. Blood clots mostly break up, but there also can be some residual swelling. And unfortunately, DVT can occur again.