Which is really worth a trip to A&E: agonising back ache — or a cat bite?
Splinters. Sleepless nights. As doctors reveal the trivial reasons people turn up to casualty — do YOU know what merits emergency care . . .
FROM sore throats to not being able to sleep, you’d be amazed what some people turn up at A&E for. As Good Health reported last week, 22,000 ‘ potentially trivial’ incidents — including hiccups — were seen in A& E last year, according to NHS figures.
Some NHS trusts have complained of people turning up with hangovers or to ask for the morning-after pill. ‘I have seen people with paper cuts in A&E on more than one occasion,’ says Dr Fiona Wisniacki, an NHS consultant in emergency medicine.
‘Research has shown that between 15 and 20 per cent of people who turn up at A&E should more appropriately have gone to their GP,’ adds Dr Chris Moulton, a consultant in emergency medicine at the Royal Bolton Hospital and vice-president of the Royal College of Emergency Medicine.
‘This is often children with infections such as earache, coughs and colds — although parents should always bring their children to A&E if they are really concerned, especially if they can’t find help elsewhere.’
However, many patients could get the same treatment by going to a local pharmacist, their GP or a High Street optician instead.
The British Medical Association warns of a pending ‘summer crisis’ in casualty departments, with patients facing ‘unacceptably’ long waits to be seen.
So, we asked the experts for some of the top reasons people come to A&E when they shouldn’t ( and what you should do instead), as well as a few surprisingly minor-sounding ailments that really can be a medical emergency . . .
SPLINTERS
‘YOu would be amazed how many people I have seen turn up in A&E because they have a thorn or a splinter in their finger during my 25-year career,’ says Dr Wisniacki.
Yet most people can easily remove the splinter at home, she says. ‘Just use tweezers or a standard sewing needle — clean the area with TCP and the needle with boiling water and manoeuvre out the splinter.
‘It might hurt, but there’s no reason you can’t do it yourself if the splinter is visible.’
Even if you can’t take out the splinter, only seek medical help if it is unusually large, as the natural turnover of cells will propel it to the surface in time.
Typically, the only splinters that need to be removed by doctors are glass ones.
‘These can break into little bits so, even if you think you have got it all out, there might be residual bits left in,’ says Dr Wisniacki. ‘Ideally, the area should be X-rayed to check if there are pieces left inside.’
You might also need medical help and antibiotics if the area around the original puncture site becomes infected. ‘In this case, the skin will look red and swollen and feel hot and painful,’ she says.
‘It may also be a sign that not all of the splinter has been removed. Even then, that would be something for a minor injury clinic or urgent care centre, rather than A&E.’
HEADACHES
PEOPlE often go to A&E with headaches that need nothing more than a painkiller and a lie- down, says Emma Hammett, a former A&E nurse who now runs training company First Aid For life.
‘One young man told me he was worried his headache was a sign of brain damage due to a bump he got on his head several years before,’ she says.
Headaches can have many causes, including tension, flu, too much alcohol, or dehydration — but most, even bad migraines, don’t require emergency care.
In fact, there is little doctors can offer in A&E that you couldn’t do at home.
The simplest thing is to drink plenty of water, as a study published in 2011 by Maastricht university in the Netherlands found.
It recruited more than 100 patients who regularly suffered from headaches and migraines and discovered frequently sipping water eased pain and reduced the need for tablets. You should also avoid alcohol, coffee and screens. ‘Very occasionally, a severe headache can signify something more serious, such as a stroke or a haemorrhage, where a blood vessel in the head starts to leak,’ says Duncan Bew, a consultant A&E surgeon at King’s College Hospital in london.
Call 999 or go to A&E if you have injured your head badly, with significant bleeding, or if you have temporarily lost consciousness.
Also, be aware of a headache that comes on suddenly, particularly if it wakes you at night and is very painful, or if you have sudden problems speaking or remembering things. This may signify a stroke.
CONSTIPATION
‘I WOulDN’T expect someone with constipation to come to A&E,’ says Emma Hammett. ‘But I have seen people writhing in agony with abdominal pain, being incredulous when an X-ray shows nothing more serious than constipation.’
As a general rule, you are likely to be constipated if you haven’t had bowel movements at least three times in a week.
Mr Bew says that, in serious cases, a patient may be given an enema in hospital, or manual evacuation.
However, in most cases, it is best to try simple things at home, such as drinking plenty of fluids and eating fibre-rich foods, including fruit, vegetables and cereals, which can help keep stools soft.
A spoonful of castor oil may help, as it causes the gut muscles to contract, though it isn’t suitable for pregnant women or under-12s.
Rarely, severe constipation can tear a hole in the bowel wall, leading to sepsis. This is usually in the elderly. ‘This can be life-threatening,’ says Mr Bew. ‘Anyone with severe pain and tenderness in the abdomen that gets worse when you move and is accompanied by fevers and chills should get an urgent GP appointment or go to A&E.’
You may have a racing heartbeat, nausea and abdomen distention (swelling and tightness), too.
NAIL INFECTIONS
SOME hospitals have reported patients turning up in distress because of broken nails or problems caused by false fingernails.
‘We frequently see patients in our dermatology clinics who have been referred from A&E with minor skin infections from damage caused during the application of acrylic nails,’ says Dr Tony Bewley, a consultant dermatologist at Barts Health NHS Trust in london.
‘The problem is that manicurists tend to push back or trim the nail cuticle, the thin layer of tissue that
joins the nail to the skin, to make the false nail fit more snugly.
‘In the process, they allow bacteria to creep under the cuticle, leading to an infection called paronychia that can become painful and causes the finger to become full of pus.’
The skin surrounding the nail can become inflamed and tender. But it rarely needs treating in A&E.
Instead, a GP or pharmacist can prescribe antibiotic tablets or creams. Steroid creams can also be used to dampen inflammation.
In very severe cases, minor surgery (under local anaesthetic) is required to drain the pus.
However, a broken nail can sometimes be a legitimate reason to go to A&E.
‘This can sound trivial, but may be very painful and require medical attention,’ says Dr Moulton.
‘False nails that are very securely glued on and then catch on something can not only rip off the acrylic nail, but also damage the underlying nail and nail bed (the delicate tissue immediately under the hard fingernail). This can also happen with natural nails.
‘If the nail is still partially attached, we may need to remove the entire nail from the nail bed.’ This is done using special forceps.
‘In lesser injuries, if a nail won’t stop bleeding, or continues to be very painful, it may still need A&E staff to look at it,’ says Dr Moulton.
CONJUNCTIVITIS
THouSAnDS turn up to A&E with the eye condition conjunctivitis, says Melanie Hingorani, a consultant ophthalmic surgeon at Moorfields Eye Hospital in London.
This is where the conjunctiva (the mucous membrane covering the whites of the eyes and the insides of the eyelids) becomes inflamed, causing sore, red eyes and a sticky discharge.
‘It’s a minor ailment and most cases could easily be diagnosed and treated by an optician, pharmacist or GP,’ says Ms Hingorani.
Treatment is the same wherever you go. Patients are given eye drops containing the antibiotic chloramphenicol to treat the bacterial infection, the most common cause.
Rubon gels with the eye lubricant carbomer can ease the soreness and redness.
‘Many patients get better even if they do nothing, as the immune system fights off the infection,’ says Ms Hingorani — though this can take several weeks.
But there are instances where A&E is necessary.
If sore, red eyes are accompanied by sudden, severe pain in the back of the eyes, it can be a warning sign of acute glaucoma, where fluid buildup in the eye puts pressure on the optic nerve, damaging sight.
unlike more typical glaucoma, which comes on slowly, this needs immediate treatment with injections to ease pressure in the eye, as it can cause blindness.
If you develop sore eyes, blurred vision and sensitivity to light, it can indicate uveitis. This is inflammation inside the eye that needs urgent treatment with steroid eye drops, as it can lead to vision loss.
BITTEN BY A CAT
‘CAT bites are one injury truly deserving of urgent medical attention,’ says Dr Martin Hunt, a consultant in A&E medicine at the West Suffolk Hospital in Bury St Edmunds. He says he has seen numerous cases of patients who develop lifethreatening sepsis as a result of untreated cat bites.
A cat bite injury that causes an open wound of any size, particularly to the hand, ‘can be devastating in terms of infection and permanent disability if not treated appropriately’, according to NICE (the national Institute for Health and care Excellence).
‘With a cat bite, there’s really not much you can do at home,’ says Dr Hunt. ‘Even if you clean the wound with an antiseptic, it’s unlikely you will get all the bugs out. cats are likely to be heavily contaminated with bacteria. The best thing to do is get to a doctor quickly.’
caught early enough, catinflicted wounds can be treated with antibiotics such as amoxicillin.
SORE THROATS
SoRE throats are usually nothing to worry about — and yet, some people still turn up to A&E, either because they can’t see a GP or they are concerned, says Myles Black, a consultant ear, nose and throat surgeon at the Royal Victoria Hospital in Belfast.
‘It can only be classified as an emergency if the throat is so sore or swollen that you can’t swallow liquids. This can lead to dehydration. You’ll need to be put on a drip, so go to A&E straight away.’
A virus is the most common cause of sore throats, but they can also be triggered by smoking, pollution or bacteria. The pain in all cases is the result of inflammation.
With most sore throats, it’s a matter of taking painkillers and plenty of fluids.
If it doesn’t settle down after a couple of days, it could be a bacterial infection and need antibiotics — but you can get these from a GP, rather than A&E.
OUT OF MEDICATION
THIS was given as one of the top ten reasons people go to A&E when they shouldn’t, in a list compiled last year by Addenbrooke’s Hospital in cambridge.
According to Dr Ilan Lieberman, a pain specialist at Wythenshawe Hospital in Manchester, the only reason to go to A&E if you run out of medication is because not taking that drug immediately could lead to a lifethreatening emergency.
‘For example, people who take injectable insulin or antipsychotic medication, which needs to be taken every day, need to get a repeat prescription immediately,’ he says.
‘This can be done at the GP — only go to hospital if there is no way of accessing your doctor.’
If you run out of prescription medicine and haven’t had your prescription renewed, you should be able to get an emergency supply for a few days from a pharmacy without it. It’s a good idea to take an old prescription or the medicine’s packaging with you.
You can also get prescriptions through A&E, out of hours, as most major hospitals will have access to a pharmacist who can provide medication and emergency prescriptions.
Even so, there are people who go to A&E if they run out of medicines such as the contraceptive pill or statins, says Dr Lieberman. ‘In these cases, it is harmless to wait until they can see the GP the following day for a new prescription.’
INSOMNIA
ALTHouGH insomnia — defined as regularly taking more than 30 minutes to fall asleep and/or difficulty staying asleep most nights for more than a month — can be debilitating, it is not classed as a medical emergency.
Yet it featured on a list of ‘worst offending’ reasons people turned up to A&E, compiled by emergency medicine doctors in 2016. ‘Insomnia should be dealt with by your GP,’ says Emma Hammett. She adds that anyone who turns up to A&E because they can’t sleep will have to wait a long time to be seen and will usually be sent home, unless they are also showing signs of severe psychiatric distress.
Professor Kevin Morgan, a sleep expert at Loughborough university, says people with insomnia need to ‘relearn’ good sleep habits, which include going to bed and waking up at similar times each day.
For those who wake in the night and can’t get back to sleep, he recommends leaving the bed. ‘Get up and do something different. Go back to bed only when you feel sleepy,’ he adds.
BACK PAIN
MISERABLE as it can be, in most cases chronic back pain is not an emergency. ‘In my experience, most people go to A&E because their back feels sore and they can’t walk properly, or are struggling to get to the toilet,’ says Dr Lieberman.
‘Back pain is only regarded as an emergency if there is a requirement for immediate surgery (preceded by scans to establish the problem).’
Telling patients to rest for 24 hours and take painkillers will be all an A&E department could recommend in most cases.
This is true even if you suspect you have a slipped disc, with back pain accompanied by shooting pain down the leg, due to a bulging disc pressing on the spinal cord. This isn’t normally an emergency, adds Dr Lieberman.
‘You need to be seen by your GP as soon as possible, who would refer you for a scan and specialist treatment, which may include surgery at a later date.’
But if back pain is accompanied by incontinence and numbness in the saddle area, you need to get to A&E quickly. This can be a sign of cauda equina syndrome, a rare, severe condition where all of the nerves in the lower back suddenly become severely compressed.
If not treated within six hours, it can lead to permanent incontinence and even paralysis.
It is usually caused by a spinal injury or a bulging disc.
If you have never experienced back pain and it develops following a recent trauma, such as a bad fall, it could be a burst fracture, where one of the bones of the spine breaks in multiple directions.
You need to be seen in hospital, either as a referral from your GP, or in A&E if it’s out of hours, as you may need surgery.