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How to Decide what an Appropriate Medical Response is for Loved Ones

I am happy that I can love my wife and my children dearly. However, the flipside of this is whenever any of them show any signs of getting sick I get extremely worried. I simply do not want anything bad to happen to them, and am worried to go to a doctor too late. My gut instinct is to go to the emergency room for every small issue, but I consciousely understand that this is not a logical response.

Do any of you have suggestions on how I can figure out what an appropriate response to different types of sickness symptoms would be?

22 comments

  • Some great clinical advice here. As others have mentioned, staying calm is important as part of the process. A few things might help with that:

    Focus on the problem and symptoms, not what might be. E.g., not "oh god are they dying???", but instead their chest hurts when they breathe in, they sound a little out of breath, they do/don't have a fever. Then work the problem in front of you. Practice bringing your mind back to what is observable.

    Part of you, maybe unconsciously, may think that they'll be safer if you're worried about them. That if your brain is constantly on alert, gaming out problems, or otherwise figuring out what might happen that your family and friends will be safer. This is anxiety speaking, not love or reason. You do not need to be in a state of worry to love someone, or to take care of them. Working towards an understanding of that can help with your default state and help keep yourself and them more safe on a crisis.

  • First of all: Stay calm. It's extremely rare for people to go to the doctor to late just due to "not caring enough" unless it's old (mostly rural)folks. (One of the first things I learned: When a farmer calls an ambulance, always take full ALS gear with you) Or caused by mental health issues or financial constraints. People are far more resilient than we generally think.

    Then: Most industrial nations have "medical helplines". In Australia it's 1800 022 222, in Canada 811, in Germany 116 117, etc. Resesarch your local number and if unsure: Call them.

    Then: Look at the so called ABCDE Scheme.(Extended version of blood goes round and round and air goes in and out and any deviation from that is bad)

    Airway: Anything that fucks up an profoundly airway for more than 30 seconds is an issue - call an ambulance. Aspiration, foreign body obstruction, anaphylaxis reaction with airway issues. Extremly runny noses (as in RSV) and associated breathing problems warrant an ED visit. (But seriously people, get your kids vaccinated)

    B: Breathing: Anything that continuously makes breathing problems is a "go to the ED" or "call an ambulance" thing. Continuously (!) is the point. It's normal for someone to have a coughing fit or breath a bit heavy when having a flu. But there is a difference between "my lungs are gonna kill me, i need to stay on the sofa and watch netflix" to "breathing has become so bad I actually have to focus on it and one flight of stairs slowly would make me feel woozy" to "okay,now I really really need to fight to breath enough ".The second one is a reason for an urgent care visit, the later one for an ambulance call. Also: Look for the lips and the area around it. Does it look blueish? If yes: Seek help. There are countless examples online. With children it's a bit more difficult, to be fair. But as a parent you often will know when - when you manage to stay calm. Signs of acute need to seek help: Children whose chest kind of "cave in" between the ribs need an ambulance. Children who can normally focus on you or other things and don't due to being focused on breathing? Call an ambulance. Children who are having audible breathing problems (as in: you hear them in a quiet room and it's not their nose) will need an ED visit. And again: If they become blueish/whiteish. But again: There is scientific proof that parents who manage to remain calm and get a calm observant look on their kid identify urgent and critical cases better than healthcare professionals. The staying calm part is hard,though.

    Circulation: In adults: For fuck sake people: If you have chest pain that is not triggered by a certain action (e.g. a pain to the wall of the chest when breathing in deeply, a slight pain when coughing, etc.) call an ambulance. And especially for women: Strange abdominal pain, neck, arm or jaw pain counts. Especially when paired with shortness of breath, when it gets worse when you exert yourself. Or when it stays more than a few hours. Or is paired with very low or high blood pressure relative to your normal blood pressure. If you feel something pulsating in spots where normally nothing should be pulsating maybe see urgent care. Previously unknown dizziness when standing up? ED.

    With children again it's a bit more difficult. The good news is: They very very rarely are compromised circulation wise,they hold themselves together for a long time (and then crash). But: It takes a lot for the latter to happen. Generally: Massive and sustained vomiting or diarrhoea are an indication to go to the ED, sooner than you would do as an adult and the smaller the earlier. A very good indicator is the recap test, look it up online.

    D is "disability" in this scheme and meant in the sense of "neurological issues". They are actually easier than most people think. It's obvious that an unconscious person should get an ambulance, as well as a seizure (please also call for febrile seizures). If someone is showing neurological deficits by either being disoriented, absent or having sensory or paralysis-like issues don't wait,call an ambulance. If someone is suddenly vomiting uncontrollably and having a headache or any other neurological issues: Get to the ED. Likely a migraine,but there is a slight chance for a very very bad other reason. (And migraines aren't fun either).

    In children look up meningism signs - can happen due to fever as well, but that's a good reason to go to the Urgent care clinic.

    E is meant here as exposure,but covers bleeding,trauma, abdominal issues and infection as well. Seek help for scaldings/burns and any bleeding that you can't stop within minutes or that requires more than a large bandaid. Seek help for anything that does belong in the body. Sustained abdominal pain that makes a child unable to be calmed down for more than 1 hour is a very good reason to go to the ED. A bladder infection in a child is a good reason to go to urgent care. An abdomen that gets hard as a brick when a little bit of pressure is applied is a reason to call an ambulance.

    Fever is a bit of a hit and miss situation, especially in children: First: Fever and sepsis are NOT the same. You can have a bad sepsis and have zero fever. (The last guy I nearly lost to fever had 34.5°C and never went beyond 36.5° before). Second: Fever sadly has the issue of causing febrile seizures and putting a lot of strain on the circulatory system. Which is bad. Third: But a bit of fever is nothing bad per se and there is more and more scientific evidence that an too aggressive approach to reducing fever is a bad idea as well in children. So...in the end it's a bit of a question of moderation. Give something when the child is actively "sick" and unable to do most things due to that. Give something when the fever goes beyond 39.5° C. Fever itself is not a reason to go to ED or call an ambulance - the symptoms that go along with it might. (And please get a proper thermometer and not one of these "forehead" or touchless ones. And don't try the house remedies of lowering fever like putting cold wet towels on the patient...they have all been proven to make it worse)

    This is just a little bit of advice. And you don't know if I really know what I am talking about. So please read up yourself. Get a first aid course and a children's first aid course. Check local resources and where urgent care options are. The ED and ambulances are the worst options - both in treatment quality, resources and often comfort.

  • Sign up for a first aid for children course. The best way to manage these feelings and fears is to be prepared to manage them directly. If you learn some first aid then you'll be able to manage a lot of problems yourself and know when you can't and need help.

  • I don't have any advice, but I just wanna say, I just think you are a lovely person that cares about family. I wish my parents even cared half as much 😞

  • Depending on your location and situation, you may have access to a nurse line or fast telemedicine (basically a zoom call with a random doctor). They can diagnose many ailments remotely, and at least tell you what the next steps should be.

  • This is a very common response for new fathers. I went through, and you just start to look for the signs and learn how to adjust. I remember for my youngest, we took her to the emergency room once, and they ended up simply upping her Tylenol dose from 5 ml to 7.5 ml because she grew so much. Keep being engaged with them, and you'll be fine. Through this all, just remember to take care of yourself as that will creep up on you.

  • Take a first aid + CPR class. You can get them that cover everything in as little as 4 hours, but try to get a longer one since they go more in depth. They cover most of the common situations and so will make you calmer when it happens because you had a couple drills. Even if you don't remember the details you will remember something - and when you call the emergency number it will come back what you are supposed to do making it easier for them to explain it.

    Everybody should take first aid and CPR classes every few years. Ideally keep your certification up to date, but even if you certification is 20 years out of date, when you need it you will have a clue and so be a lot more helpful.

  • I don't know how is your country situation. Over here it is said "don't go to emergency room unless you have an actual emergency". Triage will make you wait for longer than an actual doctor appointment in a uncomfortable room full of sick people, not the place you want to be when you have a small disease.

    Also emergency room doctors are trained more in stabilizing emergencies. For small diseases you'll get better diagnosis and treatment in a general doctor.

    I would advise in learning what constitutes an emergency or not and act accordingly.

    • Yeah, ER is almost never the right place. But if you do go to an ER, make sure it's attached to a hospital. The free standing ones are notorious for predatory billing and will take your first born after saving them. And your insurance will fight to not cover it.

      Urgent care and minute-clinic type things can be good. Primary care physicians are typically best, though they may be difficult to get an appointment for.

      Urgent care facilities commonly double as ERs. In that case, I believe they're legally required to get you to sign a specific form before they can charge you for an ER visit. Speaking from experience, it'll just about 10-40x the rates and they'll still charge you for an urgent care visit on top. Also speaking from experience, check your insurance plan before doing this. My insurance card said $150 copay for ER visits, but the plan was actually $150 + 10% (still unbelievably good in freedomland), plus they refuse to cover any of it anyway and the appeals process literally takes the better part of a year.

      That said, it can literally be the difference between life and death. Fighting insurance, while a huge PITA, is much better than a dead child. It's just the sad reality we live in, in order to have checks notes poor health outcomes and healthcare quality tied to whatever your job (if you have one) happens to offer. 🦅🇺🇸🎆

  • My wife was just making fun of me yesterday to my doctor sister in law for that one time we were camping in Germany and I went all fast and furious and parked in front of the emergency gate of the hospital when my son got stung by a bee in the neck. I try to reason myself but that day my primal instinct kicked in stronger than I could ignore.

    • [Not a doctor, take with a grain of salt] This is the only reaction I would consider appropriate in that situation. Bees kill lots of people, you don't know if you're allergic until one has stung you, and anaphylaxis acts extremely fast, specially in the neck so close to the airways.

      • Critical care Paramedic here: The reaction above is the worst one basically. Worse than doing nothing. Don't do that.

        Yes, anaphylaxis is bad and kills people. If it is that bad ,you will know that something is wrong within 60-120seconds. (That's why epipen exist)

        But: There is a shit load of things that can be done in between "getting stung" and "cardiac arrest" in terms of first aid - and emergency medical dispatchers can and will tell you what to do. None of them can be done properly in a moving private vehicle.

        But what happens - more often than it should is people doing these stunts risking the lives of others, having an accident themselves or simply delivering a dead patient to a hospital that could have easily been saved by basic first aid and an ambulance.

        And to make matters worse: You will very likely be in a even worse spot. EDs in a lot of countries(it is surely the case in Germany)are not necessarily staffed by people who are experienced with paediatric anaphylaxis patients and only a minority of hospitals deal with any paediatric patients at all. If you're unlucky an intern with 1.5 years of post graduation experience who didn't even see an adult anaphylactic reaction so far will staff the ED, has no equipment to deal with paediatric patients and one can only hope the intensivist/anaesthesiologist on duty is not currently dealing with other stuff. While ambulance staff get trained in this shit regularly, it has more than enough equipment available, and can bring in specialist staff (critcare, physician response units, helicopters) - and believe me,most ambulance systems will make that a "send everyone" call. (For my neck of the woods: Neighbourhood app alarm to send off duty personnel, volunteer first responders from a charity or closest BLS ambulance, ALS resource, physicians response car, potentially helicopter with paediatric intensivist)

        So...for fucks sake people,call an ambulance. In most industrial nations they will be faster, they will know what to do, where to transport and you won't risk crashing into other people or having a dead patient in the backseat by the time you arrive.

        (BTW: It's extremely rare for an sting into the skin of the neck to actually impede the airway due to it's location - there are very few tissues where this can become an issue. Totally different for stings within the airway and mouth, but most stings outside that lead to airway obstruction would have led to the same result for a sting into the arm. The location does not have direct causation for the location of the systemic reaction)

      • That was precisely my reasoning, we didn't know if he's allergic and especially in the neck it could've gone from fine to dead real quick, and I'm not about to improvise a tracheotomy... I get why she teases me though, I really acted like I was in an action movie lol.

  • I'd say you're doing alright. When in doubt go to emergencies and let the doctors and medical professionals decide if they send you home, unless you're in America and this would bankrupt you that is. Better to be safe than sorry, specially with your kids.

  • Have you tried talking to your own parents/older family members? They've seen most of the common problems and can give you reasonable answers.

22 comments