No matter what the emergency, the staff at Our Lady of Lourdes Medical Center and Lourdes Medical Center of Burlington County are here to help.
Sometimes you might think "is this bad enough to use emergency services?"
Dr. Alfred Sacchetti is here to to explain Lourdes emergency room services so you can feel comfortable using your local Lourdes emergency room.
Selected Podcast
When To Go To The Emergency Room
Featured Speaker:
Learn more about Alfred D. Sacchetti, MD
Alfred Sacchetti, MD
Alfred D. Sacchetti, MD, FACEP is the Chief of Emergency Services at Our Lady of Lourdes Medical Center in Camden, NJ and Assistant Clinical Professor of Emergency Medicine at Thomas Jefferson University in Philadelphia, PA. He received his bachelor's degree in chemistry from La Salle College and his medical degree from the Medical College of Pennsylvania. Dr. Sacchetti is both a dedicated researcher and enthusiastic educator with over 75 journal publications and textbook chapters, as well as over 200 national and international lectures, to his credit. His research focuses include Procedural Sedation and Analgesics, Children with Special Health Care Needs (CSHCN), and Congestive Heart Failure. Dr. Sacchetti co-authored the nation's first Emergency Medical Services for Children Law, pioneered the Emergency Information Form for CSHCN for the American College of Emergency Physician, and serves as a peer reviewer for over a dozen professional journals including the Bulletin of the World Health Organization, Journal of American Medical Association, the British Medical Journal, the Annals of Emergency Medicine, and Emergency Medicine Practice. He is past president of the New Jersey American College of Emergency Physicians and former president of the Medical Staff of Our Lady of Lourdes Medical Center. In addition to his administrative responsibilities, Dr. Sacchetti maintains a full time clinical practice as a general emergency physician.Learn more about Alfred D. Sacchetti, MD
Transcription:
Melanie Cole (Host): No matter what the emergency, the staff at Our Lady of Lourdes Medical Center are here to help. The emergency department at the medical center is well known for its advances in the treatment for all pediatric and adult emergencies. My guest today is Dr. Alfred Sacchetti. He is Chair of the Emergency Medicine Department at Lourdes Health System. Welcome to the show, Dr. Sacchetti. Tell us was constitutes, generally, an emergency. People get confused. “I’ve broken an ankle. Should I go to the emergency room?” “My head hurts. Should I go to the emergency room?” What do you tell people is your best advice when they should really call 9-1-1 and go to the emergency room?
Dr. Alfred Sacchetti (Guest): Thank you for having me on. The answer is really simple. You go to the emergency room when you think you have an emergency. What is an emergency for one person may not be an emergency for another, so you can’t make a blanket statement. One of the things is people like to have a very discreet checklist of “if I have this symptom, I should go to the emergency department. If I don’t, I should go to my private physician or maybe an urgent care center.” You can’t apply that blanketly. It really varies. For example, a mother of five may have a child with a temperature of 102 and feel perfectly comfortable taking care of that child. A mother who’s got a newborn who’s never had a child before has a temperature of 100 is absolutely apoplectic; she doesn’t know what to do with that child. When you come to an emergency department is really individualized, so you can’t just make that blanket statement. It’s determined by the individual patient.
Melanie: A lot of times, people are worried if they have chest pain--let’s just kind of start with chest pain, which can be caused by simple things like anxiety or something really more serious and emergent--that if it’s not something serious or emergent, that you guys are going to yell at them when they come in and say, “You didn’t need to come in.”
Dr. Sacchetti: If anyone criticizes a patient for coming to the emergency department, they probably shouldn’t be working in an emergency department. There is no one who has any experience in the field who would ever criticize a patient and say, “There is no reason for you to be here.” The reason for it is because we’ve all seen over the years, if you come in with chest pain and I ultimately diagnose you as having indigestion, the only way I did that was number one, I have gone to school for all the years that it takes and to have a number of years working in the department, to get the experience to do an EKG on you, to do a chest x-ray on you, to do some blood tests on you. Then I say, “We have good news. It doesn’t look like it’s your heart, it looks like it may just be indigestion.” It took me probably 3-4 hours to figure that out. Why would I ever criticize you for coming with what might have been a life-threatening event and only to have you be intimidated and not come back? We see more people die from indigestion, which really turned out to be a heart attack that they really should have been in the emergency department for, then we would never complain about people coming to the emergency department for something that turned out not to be an emergency.
Melanie: What about things like your back going out or feeling like you tore a tendon or strained a muscle? People say, “I’m going to wrap it in ice,” are those kinds of things something you go to just go to an urgent care or to the orthopod or is the emergency room the place to go for that?
Dr. Sacchetti: Again, it depends on the individual. In general, let’s take a step back again and we’ll do the specific strains, sprains and those types of things. In general, what you want to use an emergency department for is something that you are concerned about. If you think you have a serious problem, absolutely you come in and let us take a look at you. If you were working and you injured your back, the reason to come to the emergency department might be that “You know what? I was working in the yard I think I over did it. My back hurts and I took my normal over the counter regimen of pain medicine and it’s not getting any better. I’m getting worse and you know what? I really can’t get comfortable. I’m up at night now.” You know what? You may have something else going on there or you may just simply need some instruction on some different exercises that you can do. Maybe adjust the medicines a little bit. But, part of it is, also, you need relief from what is causing your problem. Just because your problem is not a dissecting aneurism that can kill you in the next hour or two doesn’t mean that you don’t have a problem that needs immediate medical attention. Acute conditions are some of those things that we see.
Melanie: When is it okay to wait? People are suffering from the flu; they think, “Oh, my gosh. I might have something worse.” Or, as you mentioned, a high fever or severe diarrhea or stomach pains. I imagine you see people with stomach aches all the time. When is it okay to wait?
Dr. Sacchetti: That’s a more difficult question to answer because there, again, I can throw it back to you and say, “Well, it depends on your experience with it. Have you had it before?” and those types of things. Part of the problem becomes, how does any medical professional tell you how to recognize something that is not an emergency? If we line ten people up with stomach pains and two of them have something bad--one has an infected gall bladder and the other has appendicitis and the other eight have self-limited problems that will go away on their own. How do we teach somebody to tell the difference between those? You really can’t. The advice would come down to, if you have symptoms that are concerning, that are getting worse, that aren’t getting better, that are preventing you from doing just normal activities – you can’t get up and walk because the pain is so bad. Or, you can’t eat because you are vomiting all the time. Or, your diarrhea has gotten to the point where you are light-headed and dizzy. Absolutely you need to be seen in an emergency department for those things. If you’ve got some abdominal pain and you have one episode of vomiting and one episode of diarrhea and you’re starting to feel better and you can tolerate some soups and what not and the pain is slowly getting better, but doesn’t hurt when you get up and walk, you might say, “You know what? I’m going to wait it out for another hour or two and see what happens.”
Melanie: What is the difference between urgent care and the emergency room?
Dr. Sacchetti: It’s interesting. Urgent care kind of sprung out of the emergency department. The major difference is that urgent care is really designed to take care of what a patient has self-selected as a non-emergency. So, they’re designed to take care of the strains and the sprains, the viruses and the stomachs and those types of things versus an emergency department which is also prepared to take care of those things but can also take care of all the life-threatening problems as well--the heart attacks, the severe injuries, the strokes. Those types of things. They overlap a little bit in terms that some people will go to an urgent care with what they think is a minor problem and it turns out to be something major and they need to be transferred to an emergency department. That happens. At the same time, there are things that we see in the emergency department that could have been taken care of at an urgent care center. But, again, you never know that until after the evaluation is done. It kind of, again, falls back on the patient to self-select and say, “I think that my problem is one that is not going to require the services of a hospital. I’ve got this stomach ache. I’ve some diarrhea. If they can just give me something to keep me from getting dehydrated and control my symptoms, I should be okay in the next day” versus “If I get up and walk it really, really hurts on my side here.” In which case, you’re much more worried about a serious infection and they need to go to the emergency department.
Melanie: Dr. Sacchetti, sometimes people are hesitant to go to the E.R., call 9-1-1, because of the cost involved. Tell us just a little bit--give us your best advice about reconciling that with themselves. “Okay, this is more important than worrying about whatever this is going to cost me.”
Dr. Sacchetti: The cost of emergency care is very, very complex and it’s intertwined with the insurance and everything else but the one thing that everybody should overwhelmingly be reassured about is the following. There is no emergency department in the nation that is allowed to turn anyone away because of their ability to pay. Before you can even be asked about how you are going to pay for the visit, you have to have what is called a medical screening exam. A healthcare professional – whether it is an emergency physician, a physician’s assistant, or a nurse practitioner, not one of the regular staff nurses, but somebody with an advanced degree – has to look at you, evaluate you, determine whether you have a true emergency or not and only at that point can they say, “You know what? You don’t have to be treated in the emergency department.” That determination may include X-rays, EKGs and lab tests. If you have any questions, you go to the emergency department. Do not ever worry about the cost of it because it is a federal law – the EMTALA law that says, “We will take care of you no matter what your financial circumstances. You will never, ever be turned away because of that.”
Melanie: Dr. Sacchetti, in just the last minute give your best advice for people that are just not sure about this confusing question of when to go to the emergency room and when it’s okay to wait it out and see what happens and why they should come to Lourdes Medical Center for their care.
Dr. Sacchetti: The reason they should come to Lourdes Medical Center for their care is because I do believe firmly that the staff there is probably amongst the best in the nation. If you look at the awards that the department has received, the publications; it’s very clear the mantra of the department is we’re not here to meet the standard of care for you. We’re here to set the standard of care for others. We have lived up to that if you look at the accomplishments in that department. That’s clearly why I think we are the best department around. That aside, when you should come to the emergency department is if you have an acute injury or a medical condition that concerns you; if something is evolving, you’re not getting better, you’re getting worse. You decided to wait and you’re actually getting worse. Or, if you have something that absolutely the symptoms can’t even remotely be described as minor. You’re having chest pain; you’re having weakness on one side; you’re having light headedness; you’re fainting – there’s nothing minor that is going to cause those things. You definitely need to come to the emergency department for those.
Melanie: Thank you so much for such great information. It’s so important. You’re listening to Lourdes HealthTalk with Lourdes Health System and for more information you can go to Lourdesnet.org. That’s Lourdesnet.org. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): No matter what the emergency, the staff at Our Lady of Lourdes Medical Center are here to help. The emergency department at the medical center is well known for its advances in the treatment for all pediatric and adult emergencies. My guest today is Dr. Alfred Sacchetti. He is Chair of the Emergency Medicine Department at Lourdes Health System. Welcome to the show, Dr. Sacchetti. Tell us was constitutes, generally, an emergency. People get confused. “I’ve broken an ankle. Should I go to the emergency room?” “My head hurts. Should I go to the emergency room?” What do you tell people is your best advice when they should really call 9-1-1 and go to the emergency room?
Dr. Alfred Sacchetti (Guest): Thank you for having me on. The answer is really simple. You go to the emergency room when you think you have an emergency. What is an emergency for one person may not be an emergency for another, so you can’t make a blanket statement. One of the things is people like to have a very discreet checklist of “if I have this symptom, I should go to the emergency department. If I don’t, I should go to my private physician or maybe an urgent care center.” You can’t apply that blanketly. It really varies. For example, a mother of five may have a child with a temperature of 102 and feel perfectly comfortable taking care of that child. A mother who’s got a newborn who’s never had a child before has a temperature of 100 is absolutely apoplectic; she doesn’t know what to do with that child. When you come to an emergency department is really individualized, so you can’t just make that blanket statement. It’s determined by the individual patient.
Melanie: A lot of times, people are worried if they have chest pain--let’s just kind of start with chest pain, which can be caused by simple things like anxiety or something really more serious and emergent--that if it’s not something serious or emergent, that you guys are going to yell at them when they come in and say, “You didn’t need to come in.”
Dr. Sacchetti: If anyone criticizes a patient for coming to the emergency department, they probably shouldn’t be working in an emergency department. There is no one who has any experience in the field who would ever criticize a patient and say, “There is no reason for you to be here.” The reason for it is because we’ve all seen over the years, if you come in with chest pain and I ultimately diagnose you as having indigestion, the only way I did that was number one, I have gone to school for all the years that it takes and to have a number of years working in the department, to get the experience to do an EKG on you, to do a chest x-ray on you, to do some blood tests on you. Then I say, “We have good news. It doesn’t look like it’s your heart, it looks like it may just be indigestion.” It took me probably 3-4 hours to figure that out. Why would I ever criticize you for coming with what might have been a life-threatening event and only to have you be intimidated and not come back? We see more people die from indigestion, which really turned out to be a heart attack that they really should have been in the emergency department for, then we would never complain about people coming to the emergency department for something that turned out not to be an emergency.
Melanie: What about things like your back going out or feeling like you tore a tendon or strained a muscle? People say, “I’m going to wrap it in ice,” are those kinds of things something you go to just go to an urgent care or to the orthopod or is the emergency room the place to go for that?
Dr. Sacchetti: Again, it depends on the individual. In general, let’s take a step back again and we’ll do the specific strains, sprains and those types of things. In general, what you want to use an emergency department for is something that you are concerned about. If you think you have a serious problem, absolutely you come in and let us take a look at you. If you were working and you injured your back, the reason to come to the emergency department might be that “You know what? I was working in the yard I think I over did it. My back hurts and I took my normal over the counter regimen of pain medicine and it’s not getting any better. I’m getting worse and you know what? I really can’t get comfortable. I’m up at night now.” You know what? You may have something else going on there or you may just simply need some instruction on some different exercises that you can do. Maybe adjust the medicines a little bit. But, part of it is, also, you need relief from what is causing your problem. Just because your problem is not a dissecting aneurism that can kill you in the next hour or two doesn’t mean that you don’t have a problem that needs immediate medical attention. Acute conditions are some of those things that we see.
Melanie: When is it okay to wait? People are suffering from the flu; they think, “Oh, my gosh. I might have something worse.” Or, as you mentioned, a high fever or severe diarrhea or stomach pains. I imagine you see people with stomach aches all the time. When is it okay to wait?
Dr. Sacchetti: That’s a more difficult question to answer because there, again, I can throw it back to you and say, “Well, it depends on your experience with it. Have you had it before?” and those types of things. Part of the problem becomes, how does any medical professional tell you how to recognize something that is not an emergency? If we line ten people up with stomach pains and two of them have something bad--one has an infected gall bladder and the other has appendicitis and the other eight have self-limited problems that will go away on their own. How do we teach somebody to tell the difference between those? You really can’t. The advice would come down to, if you have symptoms that are concerning, that are getting worse, that aren’t getting better, that are preventing you from doing just normal activities – you can’t get up and walk because the pain is so bad. Or, you can’t eat because you are vomiting all the time. Or, your diarrhea has gotten to the point where you are light-headed and dizzy. Absolutely you need to be seen in an emergency department for those things. If you’ve got some abdominal pain and you have one episode of vomiting and one episode of diarrhea and you’re starting to feel better and you can tolerate some soups and what not and the pain is slowly getting better, but doesn’t hurt when you get up and walk, you might say, “You know what? I’m going to wait it out for another hour or two and see what happens.”
Melanie: What is the difference between urgent care and the emergency room?
Dr. Sacchetti: It’s interesting. Urgent care kind of sprung out of the emergency department. The major difference is that urgent care is really designed to take care of what a patient has self-selected as a non-emergency. So, they’re designed to take care of the strains and the sprains, the viruses and the stomachs and those types of things versus an emergency department which is also prepared to take care of those things but can also take care of all the life-threatening problems as well--the heart attacks, the severe injuries, the strokes. Those types of things. They overlap a little bit in terms that some people will go to an urgent care with what they think is a minor problem and it turns out to be something major and they need to be transferred to an emergency department. That happens. At the same time, there are things that we see in the emergency department that could have been taken care of at an urgent care center. But, again, you never know that until after the evaluation is done. It kind of, again, falls back on the patient to self-select and say, “I think that my problem is one that is not going to require the services of a hospital. I’ve got this stomach ache. I’ve some diarrhea. If they can just give me something to keep me from getting dehydrated and control my symptoms, I should be okay in the next day” versus “If I get up and walk it really, really hurts on my side here.” In which case, you’re much more worried about a serious infection and they need to go to the emergency department.
Melanie: Dr. Sacchetti, sometimes people are hesitant to go to the E.R., call 9-1-1, because of the cost involved. Tell us just a little bit--give us your best advice about reconciling that with themselves. “Okay, this is more important than worrying about whatever this is going to cost me.”
Dr. Sacchetti: The cost of emergency care is very, very complex and it’s intertwined with the insurance and everything else but the one thing that everybody should overwhelmingly be reassured about is the following. There is no emergency department in the nation that is allowed to turn anyone away because of their ability to pay. Before you can even be asked about how you are going to pay for the visit, you have to have what is called a medical screening exam. A healthcare professional – whether it is an emergency physician, a physician’s assistant, or a nurse practitioner, not one of the regular staff nurses, but somebody with an advanced degree – has to look at you, evaluate you, determine whether you have a true emergency or not and only at that point can they say, “You know what? You don’t have to be treated in the emergency department.” That determination may include X-rays, EKGs and lab tests. If you have any questions, you go to the emergency department. Do not ever worry about the cost of it because it is a federal law – the EMTALA law that says, “We will take care of you no matter what your financial circumstances. You will never, ever be turned away because of that.”
Melanie: Dr. Sacchetti, in just the last minute give your best advice for people that are just not sure about this confusing question of when to go to the emergency room and when it’s okay to wait it out and see what happens and why they should come to Lourdes Medical Center for their care.
Dr. Sacchetti: The reason they should come to Lourdes Medical Center for their care is because I do believe firmly that the staff there is probably amongst the best in the nation. If you look at the awards that the department has received, the publications; it’s very clear the mantra of the department is we’re not here to meet the standard of care for you. We’re here to set the standard of care for others. We have lived up to that if you look at the accomplishments in that department. That’s clearly why I think we are the best department around. That aside, when you should come to the emergency department is if you have an acute injury or a medical condition that concerns you; if something is evolving, you’re not getting better, you’re getting worse. You decided to wait and you’re actually getting worse. Or, if you have something that absolutely the symptoms can’t even remotely be described as minor. You’re having chest pain; you’re having weakness on one side; you’re having light headedness; you’re fainting – there’s nothing minor that is going to cause those things. You definitely need to come to the emergency department for those.
Melanie: Thank you so much for such great information. It’s so important. You’re listening to Lourdes HealthTalk with Lourdes Health System and for more information you can go to Lourdesnet.org. That’s Lourdesnet.org. This is Melanie Cole. Thanks so much for listening.
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