Delayed visits to ER detrimental

Published by Contra Costa Times

Posted on Fri, Dec. 08, 2006

By Brenda Reilly, MD

A 48-YEAR-OLD MAN came to our Emergency Department (ED) two days after falling and cutting his lower lip. The lip and face had become severely infected, with redness, swelling, warmth and pus.

After admission to the hospital for intravenous antibiotics, he required cosmetic surgery and a prolonged recovery time to heal.

If he had come to the ED within 24 hours of the injury, his lip could have been repaired quickly and nearly healed within a week.

Later, a 9-year-old girl who fell off her bicycle a week earlier came in complaining of a painful wrist and a cut on her hand. Though the cut had begun to heal, her wrist pain had not improved.

X-rays of her arm showed a wrist fracture that required surgical repair. She also needed intravenous antibiotics for an infection that had entered her broken bone through the cut.

If she had been seen in emergency soon after the event occurred, she could have avoided a prolonged hospital stay.

That same day, I saw a 25-year-old man who had cut the back of his hand with a gardening tool a few days earlier. He was unable to move his index finger properly and thought it was due to the pain and swelling. He failed to realize that he had cut a tendon in his hand.

He ended up needing surgery to repair the injury in order to restore function to his finger. He had also developed an infection which required a hospital admission for intravenous antibiotics.

Again, had he come to the ED on the day of the injury he would have had a better course and outcome.

It is often difficult to know when to come to the emergency department. Lacerations (cuts) need to be seen within 24 hours for suturing. After that, the wound is usually too contaminated with germs to sew closed.

Deep cuts on the hand should be seen promptly to assess for tendon injury and to prevent infection.

Bites to the hand need to be washed out thoroughly in the ED and treated to prevent infection. Human bites (or fists cut by striking another's teeth) can be the most dangerous. Lacerations to the face require prompt evaluation to prevent infections and scarring.

Lacerations in a diabetic person, especially in the feet, are always worrisome, and need to be treated promptly to avoid infection which can lead to amputation.

Broken bones need to be splinted promptly to minimize further damage. An X-ray is a simple, fast way to determine if a bone is broken.

Children's bones have growth plates that can fracture and, if these are damaged, the injury needs special care in order to ensure the bones grow properly.

Falls in the elderly are concerning because osteoporosis weakens the bones and makes them more prone to fractures.

Broken bones that also have open wounds near the break frequently need surgical treatment to ensure the bone does not get infected.

While waiting for transportation to the ED, apply pressure to a cut to stop the bleeding. Wrap open wounds in clean gauze or a towel.

For injured limbs, elevate, immobilize (with a piece of wood and tape, if necessary) and cool with ice.

Reilly works in the Emergency Department at the Contra Costa Regional Medical Center.