When and Where Should I Seek Care?

Editor's Note: This article is authored by Amber Blackburn, RN.

As I do every winter, I have been sick for what seems like months. When you live with a chronic health condition, like heart failure or lupus, it’s just part of it. However, recently I was feeling very poorly and found myself to have some very concerning symptoms. Symptoms that, in the past, for me, were life-threatening and resulted in a week-long hospital stay.

Knowing my symptoms and what each level of care can handle, I decided going to the emergency room (ER) was my best choice. I knew that trying to get in with my primary care physician (PCP) or to be seen in urgent care would likely be fruitless.

Living with any chronic condition can make life a little more difficult. As many of you know, living with heart failure is no different. Sometimes a flare-up/exacerbation comes on slowly, and you catch it. You have time to call your cardiologist or PCP (depending on who manages yours), and get instructions for ways to handle things at home. But other times those flares hit you like a train and your only option is to seek care immediately.

So let’s discuss.

When should I go to my PCP, an urgent care facility, and/or the ER?

When should I see my PCP?

Your PCP is a good choice for:¹

• An annual physical
• The common cold, which is not getting better
• Bronchitis
• Sinus infection
• Strep throat
• Small cuts that don’t need stitches
• An injury that doesn’t require immediate attention
• You start noticing a little bit of increased shortness of breath with exertion. But your oxygen sats are good, and you’ve seen no changes in edema or on the scale

When should I avoid seeing my PCP?

You should not see your PCP for the following:^1-3

• Any trauma
• Exposed bone
• If you need IV fluids or IV antibiotics
• You’re having difficulty breathing
• Chest pain
• You have heart failure, and have gained more than 2 lbs. in a day or 5 lbs. in a week, and are feeling short of breath, and can’t lie flat when sleeping
• You’re having signs/symptoms of a stroke

When living with heart failure, it is a good idea to set guidelines with your cardiologist. Guidelines for when you should seek care, and what level of care. In most cases, they are pretty similar from practice to practice. It’s good to talk to your doctor to find out when they want you to try and get in with them. Versus when they recommend you to bypass the office visit and go straight to the ER.

When should I go to urgent care?

Urgent care is a good option if you get sick after hours, or on the weekend, with issues noted above that would be okay to be seen in your PCP office. As well as:²

• COVID/flu swabs
• Small cuts
• Sprains
• Broken bones
• Some urgent care practices can also do IVs along with IV fluids

When should I avoid urgent care?

You should avoid going to urgent care for any of the following reasons:²

• Signs and symptoms of stroke
• Chest pain/signs and symptoms of heart attack
• Shortness of breath or difficulty breathing
• Right upper corner abdominal pain (could be gallbladder)
• Right lower corner abdominal pain (could be appendicitis)

When should I go to the ER?

FIRST, you should only go to the ER for TRUE EMERGENCIES! The ER is not for things like the common cold, sore throat, or back pain you have had for 15 years! It is for the following:⁴

• Trauma of any kind
• Shortness of breath, or difficulty breathing
• High fever
• Signs of a heart failure exacerbation
• Symptoms of a stroke
• Symptoms of a heart attack
• High blood pressure (over 160/90 more than once, unless your doctor tells you otherwise. Always find out your own parameters.)
• Low blood pressure (any blood pressure under 90 systolic)
• Signs of sepsis

Signs of a heart failure exacerbation:

If you are experiencing the following, it is time to bypass calling the office and either call 911 or report to your closest emergency room:⁴

• Have a cough that brings up a pink or white foam-like substance
• Feel faint, dizzy, or start feeling confused
• Notice a loss of appetite, or are dealing with nausea
• Have new, sudden chest pain or sudden, severe shortness of breath
• A fast, irregular heartbeat
• Swelling that has gotten significantly worse in a short time
• Rapid weight gain (2 or more lbs. in a day, or 5 lbs. or more in a week)

Chest pain/signs of a heart attack:

Any time you have chest pain that is new and not something you’ve had before, you should go to the emergency department. Especially if it is felt along with pain with breathing, shortness of breath, pain that radiates to your shoulder, pain going down your arm, the feeling like there is an elephant on your chest, feeling nauseated, and/or clammy/sweaty.^5,6

Signs of a stroke:

If you feel like you or a family member/friend might be having a stroke, it is good to remember the acronym BE FAST:⁷

• BALANCE – Sudden loss of balance and/or coordination
• EYES – Sudden blurred, double, or loss of vision
• FACE DROOPING – Drooping or numbness of the face
• ARM – Weakness or numbness of arms or legs on 1 side of the body
• SPEECH – Slurred speech, unable to speak, or difficulty understanding
• TIME – If you experience any of these symptoms, call 911 IMMEDIATELY.

Signs and symptoms of sepsis:

Two years ago, I was hospitalized for sepsis. Some of the warning signs, for me, that are commonly seen are:

• Feeling generally unwell
• Feeling faint
• Low blood pressure (mine was 80/40)
• Heart rate over 100 at rest
• Temperature of 101 or higher
• Signs of some kind of infection (for me, it was a surgical site infection)
• Changes in mental status
• Sweating for no clear reason
• Shivering

Do you know when and where to go for treatment?

How do your heart failure symptoms play into your action plan? Do your loved ones know how to support your plan when you need medical treatment? Share with us in the comments below.