Body Basics

Common Pains Seen in the Emergency Department

Why does it hurt and what will the doc do? Here are the typical causes, treatment options, and aftercare for the most common causes of pain treated in the emergency department, or what’s commonly known as “The ER.”

Toothaches

Woman with ToothacheCommon cause: Cavities, infection, gum disease (known as gingivitis), exposed nerve root, or tooth fracture.

Treatment: Emergency physicians can use nerve blocks to ease pain if a root is exposed, and they can drain abscesses and prescribe antibiotics for infections. But these are only stopgap measures until you can see your dentist.

What to expect when you leave: Prescriptions for antibiotics and over-the-counter pain relievers can help, but you should see your dentist or an oral surgeon.

Cuts

Common cause: Sharp objects, such as knives or glass.

Treatment: Direct pressure is applied to stop the bleeding. Wash thoroughly with soap and water or squirt saline under high pressure to reduce infection risk. An X-ray may be ordered if an object is embedded in the wound or a broken bone is suspected. Depending on the wound size, depth, and location, closure is done with either staples (typically for scalp wounds), stitches for deep cuts, or glue or adhesive tape for superficial cuts, especially on the face.

What to expect when you leave: Deep cuts that involved a lot of debris should be looked at by an emergency physician within 24 hours of leaving the ER to check for infection. Otherwise, your primary care doctor does follow-up and suture removal five to 14 days later (facial stitches within seven days). If there are signs of infection — pus, weepiness, redness, puffiness — immediately call your primary care physician or go back to the ER.

Sprains

Common cause: A ligament — the thick band of tissue connecting bones and stabilizing joints — that is stretched or torn. Any joint (knee, hip, wrist, toe, for example) can be sprained, but the most common sprain is to the ankle.

Ankle Sprin with Ice BagTreatment: Over-the-counter pain relievers such as ibuprofen (Advil, Motrin) can relieve pain and inflammation. If you’re in severe pain, the emergency physician may order an X-ray to make sure bones aren’t fractured. Normally a cast or splint won’t be used because swelling can squeeze the area too tightly.

What to expect when you leave: Follow “RICE”: Rest the injured part; Ice the injury (20 minutes at a time to limit swelling); Compress the injured area (wrap in an Ace elastic bandage); and Elevate the injured part to reduce swelling. Pain and swelling should subside within a few days. If they don’t, see your primary care physician.

Back Pain

Common cause: Wear and tear from everyday life, lifting an object the wrong way, overuse, repetitive motion involving the use of the back muscles, or even tension. In rarer instances and depending on your age, it may be a symptom of arthritis, kidney stones, or something amiss structurally, such as a herniated disc — the soft tissue that acts as a shock absorber in the spinal column.  Senior citizens with new back pain should seek medical attention as it can be a sign of an underlying serious problem.

Treatment: Back pain can be eased with anti-inflammatories (Advil, Motrin). Narcotics, such as Vicodin, might be prescribed if pain is crippling. A more extensive diagnostic workup using imaging tests, such as MRIs or X-rays, may be done if the pain is chronic.

What to expect when you leave: Heat therapy or cold packs at home can relieve inflammation, swelling, pain, and muscle tension. If pain doesn’t subside after a few days, check in with your primary care physician.

Urinary Tract Infections

Common cause: Bacteria in the urinary tract, kidneys, ureters, bladder, or urethra (the structures urine passes through before being eliminated).

Treatment: A quick urine “dipstick” test can indicate the presence of bacteria, and antibiotics can start clearing up the infection within two days (more severe infections may take longer). Doctors may also prescribe a medication to ease pain in the urinary tract. It should help relieve symptoms until the antibiotics start working.

What to expect when you leave: Follow up with your primary care physician within one or two days if the kidneys are involved; within a week for less serious bladder infections. If fever and pain persist or symptoms get worse after two days of antibiotics, or if signs of kidney infection (chills, flank pain, high fever) are present, call your primary care physician immediately or return to the ER.

Headaches

Woman with HeadacheCommon cause: Head pain may simply be a reaction to life’s normal stressors, a migraine, or an agonizing cluster headache. In very rare instances, headaches can be a sign of something serious such as meningitis, cerebral hemorrhage, or a brain tumor.

Treatment: Prescription meds can relieve tension headaches or migraines, which often are accompanied by nausea and vomiting. If the physician feels your headache is a sign of something more serious, a computed tomography (CT) scan or other test may be ordered.

What to expect when you leave: Patients who may be suffering from a migraine headache could be referred to a neurologist who specializes in migraine management. Headache sufferers who aren’t admitted to the hospital should follow up with their family doctor if symptoms persist.

Kidney Stones

Common cause: Crystallization of chemicals in the urine. Some people are more prone to developing kidney stones than others, but living in a hot climate or consuming a calcium-rich diet can also play a role.

Treatment: Urine analysis — there may be blood in the urine and/or signs of infection — and a CT scan can spot kidney stones. Pain and antinausea meds are often given to ease symptoms until the stone is excreted when urinating. Stones too large to pass through the urinary tract have to be removed by a urologist. If patients don’t respond to medication, vomiting occurs or persists, or an infection develops, hospitalization may be required.

What to expect when you leave: Patients are often given a small strainer to catch the stone when they urinate. A lab can analyze the stone’s chemical composition and determine what promoted its formation. You will then be able to make appropriate dietary changes, which may involve drinking more fluids. People with large stones will be referred to a urologist.

Abscesses and Superficial Skin Infections

Common cause: Blockage of oil or sweat glands, inflammation of hair follicles, or skin punctures. Germs get under the skin, which prompts the immune system to swing into action. Pressure from pus gathering in the abscess, coupled with the inflammation of surrounding tissue, causes the pain. Abscesses can show up anywhere but are more common in the armpit, vagina, base of the spine, and groin.

Treatment: Opening and draining fluids from the abscess provides relief. Once the sore has been drained, the doctor will insert packing in the cavity to minimize bleeding, and a bandage will be placed over the packing. Antibiotics aren’t used unless there is a significant infection.

What to expect when you leave: The packing may need to be removed at home. Soak or flush the area for 10 minutes, three to four times a day to allow the wound to heal properly, and remove any remaining debris. Avoid using products such as rubbing alcohol or hydrogen peroxide as these liquids can be damaging to healing tissue.  The sore should heal within two weeks.

Upper Respiratory Infections

Common cause: Common cold or flu, both of which are viral, or strep throat, which is bacterial. A scratchy sore throat, cough, runny nose, sneezing, and feeling stuffy and feverish are usually caused by common cold viruses. The flu, which has similar symptoms but can also cause high fever, severe aches and pains, and exhaustion, is also caused by a virus. Strep throat, which usually isn’t accompanied by a runny nose or cough, is triggered by streptococcal bacteria.

Tongue DepressorTreatment: Antibiotics kill bacteria and may be prescribed for strep but are powerless against viruses, which is why a doctor doesn’t prescribe antibiotics for colds and flu. For colds and the flu, medications such as cough suppressants, saline drops to clear nasal passages, and pain relievers to ease muscle aches and reduce fevers are used to relieve symptoms. For the elderly or patients with weakened immune systems, the emergency physician may order a chest X-ray to rule out pneumonia, which can be treated with antibiotics.

What to expect when you leave: Colds and the flu usually last about a week. Be on the lookout for a worsening of symptoms — persistent high fever, increased phlegm, and chest pain — because pneumonia can develop.

Abdominal Pain

Common cause: Heartburn, ulcer, appendicitis, inflamed pancreas, gallstones, food poisoning, or intestinal blockage. The most common reason people with stomach aches end up in the emergency department is nausea and uncontrolled vomiting.

Treatment: A thorough physical exam to pinpoint the location of the pain, combined with questions about its characteristics, intensity, and duration (Is the pain dull or sharp? How long have you had the pain? Is it constant or intermittent?), can zero in on the possible cause. If necessary, imaging tests, such as ultrasound and CT scans, are ordered to provide snapshots of vital organs in an effort to detect blockages and inflammation. This diagnostic workup determines whether a patient needs to be admitted to the hospital, requires surgery, or can be discharged with medication.

What to expect when you leave: Because making a precise diagnosis can be tricky, patients are urged to return to the ER if they don’t feel better within 24 hours, especially if the pain worsens.

Intended as information only and not as medical advice.


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