3 common reasons for an ER visit, and how to prevent them

I am an ER doctor in Baltimore and I do not want to see you in my ER. I tell my patients that I would love to run...

July 17 2020

I am an ER doctor in Baltimore and I do not want to see you in my ER. I tell my patients that I would love to run into them in a mall or a restaurant, but otherwise, I don’t want to see them again. Emergency room visits are generally not how most people want to spend their time. Despite this, over 138 million people in the U.S. go to the ER each year. Fortunately, more people end up going home than need to stay — five times as many people are discharged as are admitted to the hospital.  However, about 10% of people who come to the ER need to be admitted for additional testing, treatment, interventions, and monitoring. Three of the most common reasons that I end up admitting people to the hospital for are often disease processes that could have potentially been prevented — infections, heart disease, and stroke.

Infections

Infections that commonly prompt a visit to the ER include upper respiratory infections (URIs) like bronchitis and the flu, skin infections, and even sepsis (a severe type of infection, from a single location, that affects the entire body); they may be due to bacteria, viruses, or other microorganisms. People with infections present to the ER with any number of symptoms, including fevers, chills, shortness of breath, cough, headache, abdominal pain, skin redness, and others.  While not all infections are preventable, certain factors make people more prone to getting them. For instance, not washing your hands is a major source of spread for viruses like the cold and flu. People with medical conditions, like obesity, diabetes, and poor immune system function are more likely to have more severe types of infections, including cellulitis (skin infection) and sepsis (infections leading to organ system failure). 

The reason for this is that having high levels of glucose in your bloodstream over long periods, as can happen in diabetes, prevents your immune system from being able to successfully fight off infections. This happens because the sugar in the blood affects the white blood cells that are the workhorses of the immune system and make it harder for them to do their job. Increased amounts of glucose also affect the pathways that the cells go through to identify and attack invading bacteria or viruses. Not only does elevated blood glucose increase your risk of getting an infection, in some cases it may also make it harder for you to recover, or more likely to have a worse outcome — this is the case with the recent worldwide epidemic of COVID-19. According to the American Diabetes Association (ADA), people with diabetes and poorly controlled blood sugars are more likely to have severe symptoms and complications. Watching your blood sugar, avoiding unhealthy food, and increasing your physical activity can help you and your immune system stay healthy.

Heart disease

Heart disease (or cardiovascular disease) is the leading cause of death for men and women in the United States, and one of the most common reasons people go to the ER. It occurs when cholesterol plaques build up along the wall of your blood vessels; this is called atherosclerosis. The processes that lead to this buildup starts early in life but may worsen in adulthood, especially if you have associated preventable risk factors. People who have high cholesterol, high blood pressure, or who smoke — all modifiable with lifestyle changes or treatment — are at the highest risk of developing heart disease. Additionally, if you have high blood sugar levels, the high sugar levels may damage the inner lining of your blood vessels, which makes you more prone to developing atherosclerotic plaque and heart disease. Other risk factors include an unhealthy diet, lack of exercise, being overweight or obese, and excessive alcohol intake. 

People with heart disease often present to the ER with chest pain and shortness of breath, though other symptoms are also common. In some cases, heart disease can lead to a heart attack or heart failure. While there may be a genetic component for some people with heart disease, healthy lifestyle changes like keeping blood sugar levels normal, eating right, exercising regularly, and avoiding smoking will help keep you out of the ER. In addition, if you have any medical conditions like high blood pressure or high cholesterol, you should follow all your doctor’s recommendations.

Stroke

The American Heart Association estimates that 80% of strokes can be prevented. Unfortunately, despite being preventable, strokes are a leading cause of death and disability among Americans. Strokes occur when a blood vessel that feeds the brain is blocked by a clot or bursts and bleeds into the surrounding tissues. Some people experience a “mini-stroke” or transient ischemic attack (TIA) — this is a major warning of an impending stroke and should not be ignored. People who have had a stroke or TIA often come to the ER complaining of a facial droop, weakness or loss of sensation on one side of the body, slurred speech, severe headaches, and trouble walking, seeing, or thinking clearly. Stroke risk factors that you can control include blood sugar, blood pressure, smoking, diet and exercise, obesity, and cholesterol levels. Combining lifestyle changes with recommendations from your healthcare provider can go a long way to keeping you healthy and out of the ER. 

People have a lot more control over their health then they realize. I see many patients in the ER who would not be there if they had been able to manage modifiable health variables like blood sugar levels, blood pressure, and cholesterol along with lifestyle factors like smoking, diet, and exercise. Please, stay healthy and take charge of your health!