Eating in the ER

When you arrive at the ER, it’s standard practice to prohibit eating or drinking until a doctor has evaluated you. This rule likely exists because sedation for a procedure or surgery is considered higher risk if you have a full stomach. However, this policy is not always practical, as the vast majority of ER patients do not require acute surgery, procedures, or sedation. It’s reasonable to ask the nurse checking you in if you can have something to eat or drink. Their answer will likely be no, but it’s also reasonable to politely ask if they can consult the doctor rather than provide a blanket response. Depending on whom you’re speaking with, this request may meet resistance. There may be reluctance to allow eating or drinking because, at the start of your visit, the only information available is your vitals and a triage note from the nurse.

I believe it’s generally better for patients to eat and drink when they come to the ER. If you are truly sick with an emergency or serious illness, eating and drinking is usually not a high priority. In fact, being able to eat and drink without vomiting is often a marker that you are stable enough to leave the ER. This is particularly true for patients who present with nausea, vomiting, or abdominal pain. If we’ve ruled out serious conditions and your symptoms are under control—demonstrated by your ability to eat and drink—it indicates that you are likely safe to go home and can continue to eat and drink, with drinking being the more important of the two.

There is also disagreement about administering sedation to patients who have recently eaten or drunk. Anesthesia, a speciality older than emergency medicine, typically deals with elective cases in the operating room, where patient conditions can be controlled. Most people are familiar with this because they’ve been told not to eat or drink after midnight before a scheduled surgery. In the ER, however, we don’t have the luxury of choosing when a patient last ate or drank. We regularly administer sedating medications to patients who, for example, just came from a bar after consuming an entire pizza and ten beers. Depending on their emergent condition, they receive sedation despite a full stomach.

This isn’t a matter of right or wrong; we are simply more comfortable doing what’s necessary despite suboptimal conditions. Would it be safer if every ER patient had an empty stomach before receiving medications? Of course. But do we have that luxury? No. That said, complications from administering sedating medications to patients with full stomachs are rare. It’s a matter of the risk-benefit ratio: the risk of not administering the medication to perform a necessary procedure is usually higher than the risk of vomiting due to a full stomach when the medication is given.