With rare exceptions, there are usually no clear answers in the ER for what causes lower GI bleeding. We have tests to check hemoglobin, which measures the amount of red blood cells you have. (When you donate blood, this is usually what you’re donating. Donating plasma or platelets is less common.) We can also check clotting factors such as platelets, as well as a test called INR, which assesses how well your blood should clot. We generally perform CT scans of the abdomen as well, but we rarely find a definitive answer.

I was doing a ride-along with a friend of mine who works for a suburban police department. It was a call for an elderly lady with back pain. We were the closest unit and arrived before EMS did.

The patient was about 80 years old, lying in her bed fully dressed, simply waiting for the ambulance. She had a history of prior back surgeries and reported that she had “broken rods” in her back. She was scheduled to have another surgery in a couple of months. She had a back brace and her rolling walker at the bedside. She was very calm and reasonable. She did not have any pain at rest, but she said it hurt too much to move, so that’s why she wanted to go to the hospital. There was no report of any new trauma.

Most people have some vague idea of what a stroke is. There has been a significant education campaign by the American Heart Association so that people can recognize a stroke quickly, call 911, and get to the ER for appropriate care. Common symptoms include inability to speak, slurred speech, facial droop, and weakness on one side of the body.

Strokes generally come in two varieties. The most common type is referred to as an ischemic stroke, which is caused by clotting of a blood vessel in the brain. This leads to damage downstream from the blockage because that area is deprived of blood flow—and specifically oxygen. The other type of stroke, which is much rarer, results from the rupture of a blood vessel in the brain. These are referred to as hemorrhagic strokes.

There are many times in the ER when I see a patient and have to pause the conversation to break it into two very distinct parts: the acute problem and the chronic problem. It may not always be a truly chronic condition, so perhaps a better way to frame it is the acute problem and the “next steps” problem.

During a shift, I saw two patients with debilitating chronic pain.

When your kids refuse to take medications for a condition that brings them to the ER, I cannot solve that problem. And you’re potentially subjecting your kids to more risks. Iatrogenic complications are not always trivial.

A 3-year-old patient with a fever was unwilling to take any medications. Mom had to use rectal Tylenol at home for her fever. She came to the ER with some nausea and vomiting. The patient was given anti-nausea medicine and a sippy cup with some juice. She refused to take it. The plan had been to then give her ibuprofen to help with the fever as well. However, she continued to refuse the juice.

When you go to the ER with chest pain, you enter a generally well-functioning system that prioritizes you. You will almost always have an EKG done within 10 minutes. This is not a guarantee, but it’s a standard metric that most emergency departments strive to meet.

So, when you present at triage, you’ll likely be escorted to a private-enough area where a nurse or technician will perform the EKG. If the department is busy, you may then be sent back to the waiting room until a provider can speak with you or an actual treatment room becomes available. If you’re fortunate enough to be placed directly into a room, you might still wait a while for the EKG results or for a provider to discuss them with you.

Patients often arrive with various ideas about their condition—drawn from personal worries, discussions with others, or online searches like Google. As a doctor, it may seem unnecessary to explicitly name conditions I know from the start are unlikely or absent. However, listing the specific things I ruled out can be valuable. It reassures patients that I took their concerns seriously, demonstrates that I thoroughly evaluated them, and builds trust and goodwill.

For guys, blood in your urine can be related to a number of things. The younger and healthier you are, the more likely it is not a serious problem. The older you are, the more likely it is a serious issue. When it comes to going to the ER for new blood in the urine, context matters.

A 45-year-old male came in last night after noticing blood in his urine (and mixed in with his ejaculate) after sex. He and his wife promptly came to the ER because this was obviously very concerning to them. He had no other symptoms. He had previously passed a kidney stone (which, of course, came with the usual amount of pain), but tonight, aside from this concerning finding, he had no symptoms to speak of and hadn’t had any recently. This had never happened before. He was otherwise healthy.

Eliminate ER Wait Times Wouldn’t it be great if every time you went to the ER, you got checked in right away and were given a room immediately? No more spending your entire visit on a hallway bed or behind a curtain—or worse yet, waiting in triage! Wouldn’t it be amazing if you saw a doctor very soon after arrival? I mean, after all, you went to the ER because you thought you had an emergency, and emergencies are time-sensitive.

People with neurologic symptoms that require an excessive number of terms to describe them are not having a stroke. Patients who are actually having a stroke most often have one extremity that simply doesn’t work. It is functionally weak, paralyzed, or flaccid—it simply does not move. Speech is slurred, and the face often droops, most noticeably at the corner of the mouth.

I had a patient last night with a history of migraine headaches. With this particular headache, she complained of pain that radiated down her neck into her right arm and hand. She described her hand as “hot” and provided an excessive number of additional descriptors for her arm: tingling, “not there,” fuzzy, warm. I’ve heard other patients use similar terms like “off” or “buzzing.”