Is Chapped Lips An Emergency?

One of last year's fun news stories was a 911 call from a man whose cat wouldn't let him in his house.  After a three hour stand off, and after the police and 911 operator finished laughing themselves silly, an officer was dispatched and apparently talked the cat down. Similar absurdities happen in Emergency Medicine.  Once when I worked in Baltimore, a mom brought her child in for chapped lips.  Thinking that no one would come to the ED for such a minor thing, I searched for the "hidden agenda," some underlying worry explaining mom's thinking.  Like if her Uncle Frim had lip cancer and she feared her son had it too. However, after an exhaustive history, there was no such issue: her son simply had chapped lips. It's sometimes difficult telling the public when to call 911 or not, and when to bring kids to the Emergency Department or not.  We want to encourage people to get emergency help so they don't blow off potentially serious issues.  On the other hand, we don't want the Emergency Department and EMS systems clogged with non-emergencies. Most pediatric ED visits are not emergencies, but families come for many reasons. First, parents get scared for their kids.  They love their kids and when they get sick or hurt, parents sometimes rush for help rather than call their doctor for advice or wait for an appointment. Often parents can't get their kid seen in the office that day.  An appointment for next week doesn't help when your child won't stop vomiting, or needs x-rays.  Sometimes when the parent does call for advice, the mom is told to go to the ED, rather than office staff taking time to talk the situation through, giving advice that could keep the child home. Sometimes when a child gets sick or hurt, a doctor's office or school is worried about caring for a potential emergency.  They aren't used to emergencies and don't want to miss something, or get sued. Almost daily we see kids in the Emergency Department who were in car crashes, seem fine, but the parents want them "checked out."  You can't fault this reasoning; they care about their kids and are worried.  However, when the "crash" involves cars backing into each other in a parking lot, and the child was strapped into a car seat, maybe an ED visit is overkill.  Unless the lot has cars speeding into their slots like the Indy 500 pit stop. Too often the ED is used as a walk-in clinic, rather than for true emergencies.  The point of this blog is to inform you about what real emergencies are, what can wait to see the doctor, and what you can take care of at home.  So let's review common issues appropriate for the ED, and things that are not emergencies. Kids who are short of breath, tugging to breathe, belong in the ED.  Of course bring any children with possible broken bones, cuts that need stitches or won't stop bleeding, or severe pain. When kids get lethargic (difficult to arouse), they need to get seen.  However, there are gradations of cuts and limb injuries, and lethargy: kids with fever get lethargic, but recover with anti-fever medicines.  If it isn't obvious if it's an emergency or not, call the doctor's office.  If they can't help, go to the column in this blog to the immediate right side of the page.  Click on your issue to read specifics about what is an emergency, and what can be handled at home. Things that are commonly not emergencies: fever, coughing, rashes.  Fever doesn't hurt kids- it doesn't cook their brains and is rarely associated with seizures.  The height of the fever doesn't correlate with how sick the kid is either: a child with a 104 temperature isn't sicker than a child with 101.  Coughing also isn't an emergency- kids cough when they get colds and if they aren't otherwise short of breath, it can wait.  Again, see the column to the right. This is a busy time of year for the Pediatric Emergency Departments, so use common sense when deciding to visit.  Use your doctor's call line, or this blog when in doubt.  But if you still can't decide, bring your child in. Better safe than sorry, but you can leave the chapped lips at home.