Did you know that Stroke is the 3rd leading cause of death and disability in the United States and the main cause of serious disability? Do you know the warning signs and what to do? Consider these 5 signs that individually or together may be symptoms of a stroke.

First – Difficulty walking: stumbling, dizziness or loss of coordination.

Second – Unclear speaking and understanding: confusion, slurred words or not finding the right words to explain what is happening.

Third – Paralysis or numbness on one side of your body or face. Your mouth may droop when you try to smile.

Fourth – Vision problems: sudden blurred, blackened, or double vision in one or both eyes.

Fifth – Sudden and severe Headache that may include vomiting, dizziness or confusion

If you or someone you know is having these signs, call 911 and seek medical help immediately. Treatment is available, but time is crucial.

Q:

Any ideas?

A: Okay, first of all, this website is “Your ER Doc” not “Your Insurance Agent,” and certainly not “Your Congressman” but I’ll take a stab at it. You have to have insurance in case something catastrophic happens, so I favor a relatively inexpensive PPO plan with a very high deductible. This will deal with large bills that could result from hospitalizations, surgeries, etc. Under ordinary circumstances however, most healthy people will not get close to their deductible. This means that you now have to avoid getting sick or hurt as much as possible to save costs. It is absolutely imperative that you take full responsibility for your health. First read my top 10 list, “How to Stay out of the ER,” and also follow the following rules below.
Here’s how many cigarettes you can smoke per day: 0.
Here’s how many alcoholic beverages you can have per day: 1.
Here’s your new diet plan (which by the way I completely stole): Eat food, not too much, mostly plants.
Here’s your list of high impact sports you can participate in: Chess.
Here’s how much faster than the speed limit you may drive: 0.
Here’s how much exercise you need: 30 minutes aerobic every other day.

I’m sorry this is restrictive my friend, but at least it’s cheap.

One thing that I learned as a resident in emergency medicine is that when a patient has cardiac arrest after a car crash, motorcycle crash or some other major trauma, those people are not going to do well.

In fact, it is rare for them to survive.

Of course, there are exceptions. One such patient was the victim of a high speed motorcycle crash into a large tree. When paramedics got to him, he was essentially dead. No pulse, no breathing. They got him intubated, started CPR, and headed toward the ER. Surprisingly, on arrival, he had regained a strong pulse and blood pressure. It was speculated that when he crashed, he was knocked unconscious, and because of how his body was positioned, he could not breath, perhaps because his face was against the ground, or something was pushing on his airway. Instead of developing cardiac arrest because of severe bleeding, head injury, etc, he had suffered a respiratory arrest, which was correctable. He ended up recovering, and proving there is always an exception to the rule.

Welcome to another installment of the Top 10 Ways to Avoid the ER

Number 4 – Drugs

Drugs like methamphetamines, heroine, and cocaine are the scourge of every emergency department I have worked in. Meth is the biggest problem now. If these drugs did not exist, I have no doubt that health care costs would be much lower, people would be much happier, and my job would be way easier.

Dear Your ER Doc:

I have seen you write about the dangers of carbon monoxide poisoning before. I recently read an article where victim’s were taken to a hospital that had specialized facilities for treating this condition. Can you explain what these are and if they are common at most hospitals?

A:

Carbon Monoxide poisoning is usually treated by high-flow (100%) oxygen. All hospitals have the capability for administering oxygen to patients who have been exposed to carbon monoxide. Occasionally, severe cases of carbon monoxide poisoning are treated in Hyperbaric chambers.

Patients can be placed in these chambers where they can breath oxygen that is at higher than atmospheric pressure. Most hospitals do not have hyperbaric chambers, but patients may be transferred to a hyperbaric center if necessary.

Can you tell me more about sulfite sensitivities and any symptoms which may accompany a reaction? Thanks for your insight into ER medicine. Always informational and some times quite humerous.

Shelly
West Covina , CA

A:

Great question Shelly!

In the ER we see patients with allergic reactions all the time, and a large percentage of the time, we can’t figure out what caused it. This is because there are so many different potential sources of allergy out there (food, medications,plants, animals, detergents, mold, etc.). Sulfites are yet another possible source of allergic reaction, and one that we often forget to consider.

People can develop sensitivities to sulfites at any point, and about 1 percent of the population tends to be affected. It used to be common to spray fresh produce with sulfites and this practice has now been banned. Food that contains sulfites must have it listed on the ingredient label now. Those who are sensitive might develop asthma symptoms, GI upset, rash, or even severe allergic reactions like anaphylaxis. If you suspect you may have a sensitivity to sulfites, or other allergies, I would recommend evaluation by an allergist. They can help identify what is causing your symptoms and suggest a treatment plan.

Thanks for the question!

Q:

How do you feel about the use of cough syrups?

Mark – Portland, OR

A:

I’ll admit I’m not a big fan of cough suppressants. I frequently am asked for a prescription for medication to “just stop me from coughing.” But it’s important to remember that there is a reason for the cough. The body is trying to get rid of debris in the lungs, and infectious material. It isn’t necessarily a good idea to simply stop the cough from happening.

Cough suppressants like codeine act on brain to decrease the cough reflex. Better than simply stopping the brain from wanting to cough are treatments that allow the lungs to clear infection, and to heal. This includes steam therapy, expectorants to clear mucous, and staying hydrated. Cough drops can help an irritated throat feel better and decrease cough. Sleeping with the head elevated can also be useful. Some patients benefit from inhaled medications to relax the airways and allow improved airflow. Antibiotics are sometimes indicated, as well as steroids such as prednisone.

Most of the time, to determine the best solution to a cough, a visit to the doctor is needed to take a history and listen to your lungs. For patients that have a dry, hacking cough that is keeping them awake, cough suppressants may be an option, but it shouldn’t be an automatic.

Q:

Dear ER Doc,

I have been hearing about the low carb diet lately and am thinking about trying it out.  Is this just another fad diet or is there some science behind it?  I need to lose about 50 pounds.

Lisa, Fresno CA

A:

Lisa, there certainly are a lot of fad diets out there that don’t have any scientific basis, but low carbohydrate diets are not among them.  Recently, a study was published in the New England Journal of Medicine which compared 3 diets against each other–a traditional low fat diet, a Mediterranean diet, and a low carbohydrate diet.  The low carbohydrate diet was based on the “Atkins diet” which has been in use for many years.  In this study, the low carbohydrate diet compared very favorably to the other diets, both in total weight loss and improvement in cholesterol profiles, despite the fact that calories were not restricted in this group.  There were some limitations to the study, and further research will be required (as usual), but overall, this is helpful information.  If you are interested in pursuing this option, I urge you to speak to your physician and get more information regarding both diet, and exercise.  I applaud your desire to make healthy changes, which include weight loss, and I’m sure it will lessen your chance of visiting me in the ER!