How to Know When to Go to the ER vs. Urgent Care

 by Monya De, MD MPH

How can you tell when a visit to the ER is necessary? Sometimes cost-efficient urgent care centers are a better bet, other times an ER trip is warranted.


In this era of Dr. Google and rampant self-diagnosis, it's becoming increasingly more confusing about where you should go when you're injured or feeling sick — should you call your primary care doctor, visit an urgent care center or head straight to the ER? Often, the answer to that question isn't always so black and white. Of course, life-threatening emergencies — a heart attack, bleeding that won't stop, loss of vision, broken bone, serious head injury — absolutely require a visit to the ER. For other conditions that aren't emergencies but still require care within 24 hours, urgent care may be the best option, saving you some time, money and inconvenience in the process. Here are some tips to choose the right place to go, should you fall ill or be injured.

PLEASE NOTE: This article is not to be construed as medical advice. For diagnosis and management of any medical condition, see your doctor.

UTI or Bladder Infection

The most common symptoms associated a urinary tract infection (UTI) or bladder infection are a frequent urge to urinate and burning with or during urination. The usual treatment for a UTI is an antibiotic that an urgent care doctor can readily prescribe. But, if these symptoms are also accompanied by high fever, back pain, vomiting, or the feeling of being "sick all over", head to the ER. An infection that tracks up to the kidney, causing these symptoms, can lead to sepsis, a severe dysregulation that occurs when the body is overwhelmed with a bacterial infection. This is doubly true for pregnant women, the elderly, and anyone with recent surgery or a serious illness, like cancer or multiple sclerosis.

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Chest Pain

Persistent chest pain — especially if it radiates to your arm or jaw, is accompanied by sweating, vomiting or shortness of breath, or lasts longer than two minutes — warrants a trip to the ER. It could be a heart attack, in which case the ER will have a cardiologist on call to get you the treatment you need immediately. Remember that even 30- and 40-year-old adults have heart attacks, so age is not a reason to think twice about getting emergency care.

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Broken Bone or Dislocation

If you are injured and suspect a broken bone, compound fracture (the bone is protruding through the skin) or dislocated joint, head to the ER, where there is equipment and medication to evaluate your condition and, if needed, an orthopedic surgeon on call. For minor sprains or strains — maybe you twisted your ankle but can still walk on it — the urgent care can take an X-ray and recommend follow-up care with a specialist if needed.

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Difficulty Breathing

If you are experiencing mild to moderate breathing difficulties — for example, maybe you are coughing, wheezing and have nasal congestion but can talk in full sentences and eat — the urgent care can probably help you with a breathing treatment. But if your symptoms are severe — i.e., you are gasping and can't speak or are turning blue — you need to head to the emergency room ASAP.

Nausea and Vomiting

Most cases of food poisoning or other causes of nausea, vomiting and diarrhea can be taken care of in the urgent care. Call ahead to make sure the clinic offers IV fluids as they can really speed up recovery. If it's particularly severe and persistent, however, or you're unable to keep down any food or water at all, head straight to the ER. This could be a warning sign of something more serious like pancreatitis or an intestinal obstruction. Also, if you see any kind of blood or suspicious darkness, that could be a bleeding ulcer and also warrants a visit to the emergency room.

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Fever or flu can be typically treated in urgent care if you are otherwise healthy. Fever or flu are entirely different matters, though, in someone with cancer or HIV/AIDS or who is on drugs that suppress the immune system. If you fall into one of these categories and have a high fever, the emergency room is the best choice for you: The same pneumonia that means a few days of missed work for a healthy person can be much more serious for people with these illnesses.

Vaginal Bleeding

Pregnant women who experience vaginal bleeding and can't get a hold of their regular health care provider should err on the side of caution and go directly to the emergency room. Though there are many reasons for spotting or bleeding during pregnancy and most are not life threatening for the woman or the fetus, it's best to get evaluated in case of a more serious issue like miscarriage. This is even more important if you experience excessive bleeding — soaking a pad in less than an hour — or the bleeding is accompanied by pain or cramping.

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Eye Injuries

The urgent care is equipped to handle the removal of small foreign bodies, such as a speck of sand, from the eye and can treat conjunctivitis (pinkeye). If you see blood or bruising around your eye, or if you have vision changes or difficulty moving your eyes normally, head to the ER.

Dramatic Changes in Behavior

If you notice that a friend or loved one is experiencing an altered mental status or confusion, including loss of vision, sudden numbness, weakness, slurred speech, or inability to stay awake or recognize people, go to the emergency room immediately. They could be experiencing a seizure, stroke or other serious condition that can be life-threatening.

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What Do YOU Think?

Have you had an experience where you went to the ER and could have saved time by going to an urgent care center instead? Share your stories and thoughts below!


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