When should I go to the Emergency Room (ER)?

When to Go to the Emergency Room

Call 9-1-1 immediately and go to the ER if you experience chest pain, stroke symptoms (face drooping, arm weakness, speech difficulty), severe difficulty breathing, anaphylaxis, loss of consciousness, or any life-threatening emergency—do not drive yourself or wait to see if symptoms improve. 1

Life-Threatening Conditions Requiring Immediate ER Visit

Chest Pain or Heart Attack Symptoms

• Call EMS (9-1-1) immediately for any chest pain or signs of heart attack rather than transporting yourself to the hospital 1
• Go to the ER if you have:
  • Chest discomfort lasting more than 5 minutes (pressure, tightness, heaviness, squeezing) 1
  • Chest pain with shortness of breath, sweating, nausea, or lightheadedness 1
  • Pain radiating to arms, jaw, neck, or back 1
  • Sudden, severe "ripping" chest pain (may indicate aortic dissection) 1
• While waiting for EMS, chew 162-325 mg aspirin if you have no allergy or recent bleeding 1
• Do not take more than one dose of nitroglycerin before calling 9-1-1—if symptoms persist or worsen after 5 minutes, call immediately 1

Stroke Symptoms (Use FAST Assessment)

• Call 9-1-1 immediately if you notice any stroke signs, even if symptoms resolve 1
• Go to the ER for:
  • Face drooping on one side 1, 2
  • Arm weakness or numbness on one side 1, 2
  • Speech difficulty or slurred speech 1, 2
  • Time to call 9-1-1 immediately 1
• Additional stroke warning signs requiring ER evaluation:
  • Sudden vision loss or double vision 1
  • Sudden severe headache 1
  • Sudden confusion or difficulty understanding 1
  • Loss of balance or coordination 1

Critical pitfall: In patients ≥75 years old, stroke may present atypically with shortness of breath, syncope, acute confusion, or unexplained falls without obvious weakness—still go to the ER 1, 3

Severe Allergic Reactions (Anaphylaxis)

• Call 9-1-1 immediately for suspected anaphylaxis or severe allergic reaction 1
• Go to the ER if you have:
  • Difficulty breathing or throat tightness 1
  • Swelling of face, lips, or tongue 1
  • Widespread hives or rash 1
  • Dizziness or loss of consciousness 1
• Use epinephrine auto-injector (0.3 mg for adults >30 kg) immediately if prescribed, then still go to ER 1

Breathing Emergencies

• Go to the ER for:
  • Severe difficulty breathing or shortness of breath at rest 1
  • Inability to speak in full sentences due to breathlessness 1
  • Blue lips or fingernails 1
  • Chest pain that worsens with breathing (may indicate pulmonary embolism, pneumothorax, or pericarditis) 1, 3, 4

Loss of Consciousness or Altered Mental Status

• Call 9-1-1 for unconsciousness, seizures, or inability to follow simple commands 1
• Go to the ER for:
  • Fainting or near-fainting episodes 1
  • Sudden confusion or delirium 1
  • Seizures 1

Severe Hypoglycemia (Low Blood Sugar)

• Call EMS immediately if the person is unconscious, having seizures, or unable to swallow safely 1
• For mild hypoglycemia with ability to swallow: give glucose tablets or dietary sugar, wait 10-15 minutes 1
• If no improvement after 10-15 minutes or condition worsens, call 9-1-1 1

Key Principles for ER Decision-Making

When to Call 9-1-1 vs. Drive Yourself

• Always call 9-1-1 for chest pain, stroke symptoms, severe breathing problems, or loss of consciousness—EMS provides critical advantages including prehospital ECG, trained personnel, and faster treatment 1, 3
• EMS can begin life-saving treatment en route and alert the hospital to prepare 1

Office or Urgent Care vs. Emergency Room

• If you're at a doctor's office with suspected heart attack or stroke symptoms, you should be transported urgently to the ER by EMS, not driven 1
• Do not delay transfer from office settings for additional testing like troponin—go to the ER immediately 1, 3
• Unless a clear non-cardiac cause is evident, an ECG should be obtained; if unavailable in the office, go to the ER 1

Critical Timing Considerations

• For chest pain suggesting heart attack: Every minute matters—treatment within 30 minutes of ER arrival significantly reduces mortality 1
• For stroke: Treatment within 90 minutes of symptom onset is optimal—"time is brain" 1
• Patients with stroke symptoms within 48 hours are at highest risk for recurrent stroke and require immediate ER evaluation 1

Common Pitfalls to Avoid

• Do not assume chest pain relief with nitroglycerin means it's not a heart attack—this is not diagnostic 1, 3
• Do not assume chest wall tenderness excludes serious disease—7% of patients with reproducible tenderness have acute coronary syndrome 1, 3
• Do not wait to see if symptoms improve—for heart attack and stroke, waiting increases risk of death and disability 1
• Sharp or "electrical" chest pain does not rule out cardiac causes—objective testing is still needed 3, 4