Emergency Room Visit

There are a lot of things that an emergency room visit can and cannot do for you. Here are a couple of things that you should know: most Emergency rooms (ER’s) function to triage patients. That means that the doctors who work there are experts on deciding who needs to be admitted to the hosptial immediately (someone who has been in a car crash and is unconscious), who needs treatment for a couple of hours (someone with an asthma attack), and someone who can see their regular doctor when the office is open (a lot of kids with some types of fractures).

Here are a couple of simple Emergency Room Rules to live by:

If the skin is broken and the bones are sticking out — GO TO THE ER

If the hand or foot is white and does not seem warm, or it is numb — GO TO THE ER

If the arm of leg is obviously bent (this can be hard to tell in the elbow) — GO TO THE ER

If your child seems basically OK, if the skin is intact, if the hand or foot is warm, has normal sensation, and a good pulse, and if the arm or leg looks straight, you may decide to wait and see your doctor when you can.

No matter what, if you go to the emergency room, DO NOT EAT ON THE WAY. If the fracture needs to be straightened out, the patient has to be NPO (which is doctor talk for nothing by mouth) for 3 to 6 hours, depending upon age, prior to the procedure.

Having to wait to have an anesthetic administered so that your child’s broken bone can be straightened out is a huge source of frustration for parents and causes a lot of anxiety for the child as well.  The reason why it is prudent to wait is as follows: when an anesthetic is administered the sphincter at the bottom of the esophagus relaxes and if the stomach is full, those contents can be regurgitated and spill into the trachea and contaminate the lungs.  This is called an “aspiration” and it can cause severe problems such as a terrible pneumonia or inflammatory reaction in the lungs that can be life threatening.  In order to reduce the chance of aspirating, the American Society of Anesthesiologists have developed a set of guidelines for how long someone should go without food before having an anesthetic.  The suggested times are as follows:

Ingested Material Minimum Fasting Period

clear liquids — 2 hours

breast milk — 4 hours

infant formula — 6 hours

non-human milk — 6 hours

light meal —  6 hours

  • These recommendations apply to healthy patients who are undergoing elective procedures.  They are not intended for women in labor.
  • Following the guidelines does not guarantee that complete gastric emptying has occurred.
  • The fasting periods apply to all ages.
  • Examples of clear liquids include, water, fruit juices without pulp, carbonate beverages, clear tea, and black coffee.
  • Since non-human milk is similar to solids in gastric emptying time, the amount ingested must be considered when determining an appropriate fasting period.
  • A light meal typically consists of toast and clear liquids.  Meals that include fried or fatty foods or meat may prolong gastric emptying time.

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