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 (facial droop, arm weakness, speech difficulty), severe difficulty breathing, anaphylaxis, loss of consciousness, seizures, or any symptoms suggesting a life-threatening emergency. 1

Life-Threatening Conditions Requiring Immediate ER Visit

Chest Pain or Heart Attack Symptoms

• Call EMS (9-1-1) immediately rather than driving yourself to the hospital if you have chest pain or other signs of heart attack 1
• Go to the ER for chest discomfort lasting more than 20 minutes at rest, especially if accompanied by:
  • Shortness of breath 1
  • Diaphoresis (sweating) 1
  • Nausea or upper abdominal pain 1
  • Lightheadedness or syncope 1
  • Palpitations 1
• An ECG must be obtained within 10 minutes of arrival to evaluate for heart attack 1, 2
• Even "electrical" or sharp chest pain does not rule out cardiac causes and requires objective testing 2, 3

Stroke or TIA Symptoms

• Use the FAST assessment: Face drooping, Arm weakness, Speech difficulty = Time to call 9-1-1 1
• Call 9-1-1 immediately for any of these symptoms, even if they resolve 1
• Additional stroke symptoms requiring immediate ER evaluation include:
  • Sudden vision loss in one or both eyes 1
  • Sudden severe headache 1
  • Sudden difficulty walking or loss of balance 1
  • Sudden confusion 1
• In patients ≥75 years old, consider stroke when shortness of breath, syncope, acute delirium, or unexplained falls occur 1, 2
• The highest risk period for recurrent stroke is within the first 48 hours, making immediate evaluation critical 1

Severe Allergic Reaction (Anaphylaxis)

• Call 9-1-1 immediately for suspected anaphylaxis or severe allergic reaction 1
• Administer epinephrine auto-injector if prescribed:
  • 0.3 mg for adults and children >30 kg 1
  • 0.15 mg for children 15-30 kg 1
• Consider repeat dose after 5-10 minutes if no improvement and EMS has not arrived 1

Severe Breathing Difficulty

• Go to the ER for severe asthma attacks not responding to prescribed inhalers 1
• Seek immediate care for sudden shortness of breath with chest pain (possible pulmonary embolism or pneumothorax) 1, 3

Altered Mental Status or Neurological Emergencies

• Call EMS immediately if you are unconscious, having seizures, or unable to follow simple commands 1
• Sudden severe confusion or delirium requires immediate evaluation 1

Conditions Requiring Urgent (But Not Necessarily Emergent) ER Evaluation

Hypoglycemia in Diabetics

• If conscious and able to swallow: take glucose tablets or dietary sugars first 1
• Call EMS if unconscious, seizing, unable to follow commands, or no improvement after 10-15 minutes of treatment 1

Suspected Pericarditis

• Sharp chest pain that worsens when lying flat and improves when sitting forward, especially with fever 1, 3
• Requires ECG and inflammatory markers 3

Suspected Aortic Dissection

• Sudden "ripping" or "tearing" chest pain, especially with radiation to the back 1
• Particularly concerning in patients with hypertension or known aortic abnormalities 1

Critical Pitfalls to Avoid

• Never assume chest wall tenderness excludes serious disease—7% of patients with reproducible chest wall tenderness have acute coronary syndrome 2
• Do not use nitroglycerin response as a diagnostic test—relief does not confirm or exclude heart attack 2
• Do not delay calling 9-1-1 to take multiple nitroglycerin doses—if chest pain is unimproved or worsening after one dose at 5 minutes, call immediately 1
• Never drive yourself to the hospital with suspected heart attack or stroke—EMS provides critical prehospital care and faster treatment 1
• Do not wait for symptoms to worsen—act within 5 minutes of recognizing serious symptoms 1

When Office or Urgent Care May Be Appropriate

• Stable chest pain without high-risk features can be initially evaluated in an office setting only if an ECG can be performed immediately 1
• If ECG is unavailable in the office, refer to the ER 1
• Never delay transfer to the ER for troponin testing in office settings—transport suspected cardiac patients immediately 2