This Patient Guide serves as a resource for people who aren’t sure whether or not their symptoms – or the symptoms of a loved one – require contacting a doctor. As a general rule, a physician should always be contacted immediately if a person's health is in question. This is particularly important for people who have heart conditions or respiratory problems.

It is vital that individuals recognize signs or symptoms that indicate the need for emergency medical help. In addition, individuals should be aware of signs or symptoms that signal the need for evaluation by a physician.

Call 9-1-1 immediately if you experience symptoms of a possible heart attack:

Women may be more likely to experience a feeling of severe indigestion or pain in the breast when they are having a heart attack. If you think you might be having a heart attack, it’s better to be safe than sorry: call 9-1-1 and then chew an adult aspirin (or four baby aspirins) while waiting for help to arrive.

You should also call 9-1-1 if you experience symptoms of a possible stroke:

• Vision difficulties or hearing problems, particularly if they occur on one side of the body
  
  
• Confusion or disorientation
  
  
• Dizziness or loss of balance/coordination
  
  
• Numbness or weakness on one side of your body that can affect motor movements (e.g., walking, grasping, smiling)
  
  
• Seizures
  
  
• Severe headache
  
  
• Trouble speaking or understanding speech
  
  
• Pain upon looking at or into a light
  
  
• Painful or stiff neck

Whereas chewing an aspirin is often recommended for people who think they might be having a heart attack, people should NOT take aspirin if they think they might be having a stroke. Aspirin could make a stroke worse.

When in doubt about whether you might be experiencing a heart attack or stroke, call your doctor, 9-1-1 or go to the emergency room. You should not attempt to drive yourself or walk to the emergency room. If no one is available to transport you, call 9-1-1.

You should not wait for the symptoms to disappear – the more time that passes, the more damage that can occur. Individuals should be immediately transported to a hospital if they believe they are having a stroke or heart attack. A drug known as tPA (tissue plasminogen activator) has been shown to dissolve blood clots related to heart attacks and strokes. However, for it to be effective in reducing damage it must be given to the patients within a few hours of their initial symptoms.

Other symptoms that need to be assessed by a doctor as soon as possible include:

• Pain in the legs that worsens when walking
• Rapid or galloping heartbeats (palpitations)
• Any sudden worsening in a symptom or condition
• Dizzy spells or fainting
• Excessive fatigue
• Swelling in the limbs, particularly lower legs or ankles
• Abdominal pain or bloating that doesn’t go away after passing gas or a bowel movement
• Nausea or upset stomach
• Feeling like you are going to faint
• Sweating, often heavy and cold

Finally, people who are undergoing a procedure or surgery should discuss symptoms and recovery with their physicians.  Sometimes a doctor will say that the symptoms are perfectly normal, though they may continue to worry you. In those situations, try to relax and focus on your recovery, letting your doctor know if the symptoms get any worse.

Signs that should be brought to the attention of a healthcare professional immediately include:

It is not uncommon for young people to experience chest pain that may be perfectly harmless (e.g., growing pains or transitory benign chest wall pain). However, only a doctor can determine the cause of chest pain. Therefore, call a doctor immediately if your child or teenager reports chest pain, pressure or discomfort.

Unless trained as physicians, parents are unable to determine whether or not their child might be having a stroke. Although this condition is not very common in children through the age of 14, it does strike approximately 2.5 per 100,000 children. Unfortunately, parents may wait as many as two to three days to seek assistance for a child. This may be because common stroke signs and symptoms such as speech- and movement-related disorders are more readily noticeable in adults. It is recommended, therefore, that any unexpected neurological or behavioral problem in children and young adults be explored under the care of a physician. In addition, children and young adults with a known congenital or acquired heart disease, or sickle cell anemia, should be carefully examined for potential problems that may increase their stroke risk and/or the need for preventive treatment.

It is also important not to give aspirin to children and teenagers under age 18 who are recovering from chicken pox, flu or other viral illnesses. In this age group, aspirin, as well as medications that contain aspirin (salicylate) increases the risk for an uncommon, but potentially life-threatening disease called Reye syndrome.

As a general rule, if a spouse, family member or friend describes symptoms to you that are of concern, it’s safer to encourage them to contact a doctor than to guess on the reason. Heart-related symptoms such as chest pain and palpitations might be caused by factors such as stress or caffeine use, but they may also be signs of a more serious underlying condition. Make sure that a physician has made a diagnosis before offering ideas and suggestions about causes, treatments and so forth.

If someone is having symptoms after a procedure or surgery, find out what the doctor said to expect. For example, a doctor may say that a new pacemaker recipient is free to do whatever he or she wants, as long as the person does not raise their arms over their head or make sudden movements.  These family members don’t need to worry themselves with questions like, “Are you sure you can cook? Are you sure you can drive?” Find out from the doctor what to expect. Any symptoms that worsen or were not mentioned by the doctor as something to be expected should be reported to a doctor immediately.

As a general rule, new or worsening symptoms of a parent or other elder should be evaluated by a physician. For example, if an older person has been experiencing shortness of breath that becomes severe for no apparent reason, or if an older person begins to experience angina more frequently, they need to be seen by a physician. However, it is important to remember that older people who are free of dementia are independent adults, not children. They might not want to follow through on a doctor’s recommendation for treatment. Some experts believe this may be a sign of depression, which is believed to be largely undertreated in the elderly population. Other experts believe that emotionally healthy elderly people have the right to decide for themselves how they wish to continue their lives.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to when they should call a doctor:

1. What symptoms for me always indicate an emergency situation?
   
   
2. If I experience symptoms of concern, should I contact my doctor before 9-1-1?
   
   
3. How long should I let my symptoms continue before calling a doctor?
   
   
4. Does my medical history alter how I should address symptoms?
   
   
5. How do I know if I should call an ambulance or just schedule an office visit with a doctor?
   
   
6. Do I need to go to an emergency room or can I go to a walk-in clinic?
   
   
7. Is there a number where I can reach you in case an emergency occurs when your office is closed?
   
   
8. How do I know that my infant or child has symptoms requiring immediate attention?
   
   
9. What previous medical conditons make me more likely to have a medical emergency?
   
   
10. Should I have a lifeline device for emergency situations?