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Doctor or ER? Making the right decision Loren Yamamoto, M.D., M.P.H., M.B.A. “You know your child best, so you’re the best judge of determining when something is wrong,” says Loren Yamamoto, M.D., M.P.H., M.B.A., U.H. professor of pediatrics and Pediatric Emergency Medicine Director at Kapi‘olani Medical Center. Often, children will become ill or injured when your doctor’s office is closed. Knowing more about childhood emergencies can assist you in making a decision. Call your physician to discuss your child’s condition If your physician is unavailable, or you believe that you cannot wait, then seek emergency care. Having an emergency plan developed with your physician ahead of time can be very helpful. Below are some general guidelines to follow when deciding to seek emergency care: Fever is more serious when it occurs with fussiness, irritability or lethargy. Seizures are more serious when they last more than 2–3 minutes, recur, involve only part of the body, occur for the first time, or occur without a fever. Seizures are less serious when they occur with high fever from 6 months to 6 years, and the child is otherwise active, alert and playful. Seizures are usually followed by drowsiness, which gradually resolves. If drowsiness persists or if the child was drowsy or lethargic before the seizure, this is potentially more serious. Trauma is often serious when it involves a car or high-speed accident (bicycle, skateboard, etc.). Persistent pain, visible deformities, significant swelling, or loss of function or sensation are also serious. Difficulty breathing is usually an emergency. Abdominal or pelvic pain can be an emergency. Appendicitis or injured internal organs are difficult to distinguish from minor conditions, such as constipation or stomach flu. Testicular pain is an emergency. Chest pain is rarely an emergency in children. Vomiting/diarrhea is more likely to be an emergency if it is severe, accompanied with abdominal pain, or if fluid intake is not keeping up with fluid loss. Severe pain in general is an emergency since no one should endure pain unnecessarily. Other conditions that are often emergencies include loss of function or sensation, sudden weakness, significant tingling, rapid change in vision, confusion, agitation, cyanosis (bluish or purplish color to the skin), pale skin color, dramatic skin rashes, swelling, suicidal behavior and severe depression. A complete list is not possible. Call your physician or seek emergency care if you are unsure. Kapi‘olani Medical Center’s emergency room is open 24 hours a day, with a specially trained pediatric emergency team. If a specialist such as a surgeon or cardiologist) is required, pediatric subspecialists are on staff and can be contacted to assist with care for your child.