When to visit the e.r.

Your chest hurts.

Your legs feel weak.

You can't seem to catch your breath.

And it's 8 p.m. Can it wait until your doctor's office opens tomorrow morning? Or is this an emergency?

There are some symptoms that clearly signal a trip to the E.R., says emergency nurse Brenda Butler. Those listed to the left -- indicating a potential heart attack or stroke -- are among them.

Also on the list are symptoms like obvious bleeding that cannot be controlled with pressure, seizures and obvious bone deformity, among others. Knowing when to go -- as well as what to bring with you and what to expect upon arrival -- is invaluable when it comes to emergency medical services, says Butler, who works at Southeast Missouri Hospital.

EMERGENCY SYMPTOMS

Symptoms of stroke or heart attack should be dealt with immediately. The American Stroke Association says that primary symptoms include sudden numbness or weakness of the face, arm or leg, especially on one side of the body. Sudden confusion, dizziness, or headache and trouble speaking, seeing, walking, or balancing could also be signs of stroke. Heart attack symptoms are more difficult to deterimine, because they are different for every person, and different for women and men. The American Heart Association warns that while the most common heart attack symptom for both men and women is chest pain or discomfort, other symptoms can include shortness of breath, nausea or vomiting, and back or jaw pain.

Butler says women are notorious for ignoring these warning signs, and that every person experiencing symptoms should take them seriously.

"I'd just as soon see patients with heartburn so we catch that one (heart attack)," she says.

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Women are notorious for ignoring these warning signs - every person experiencing symptoms should take them seriously.

-Brenda Butler

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TRACKING SYMPTOMS

Not only is it important to come in at the onset of symptoms but, says Butler, so is being able to account for when they began. For certain emergencies, like stroke, the time since onset is very important in determining treatment.

All emergency facilities in the area operate using triage. This system treats medical emergencies in the order of their severity; it is not first come, first serve. While this may be frustrating to someone waiting with an uncomfortable sprain, it may also save the life of someone suffering a heart attack. For this reason, there is no average emergency room wait. Butler says that, in a 12-hour shift, she may assess 60 to 70 people for triage.

However, most people will experience a wait of some length. Therefore, bringing something to read or keep children busy is a good idea, but don't bring snacks as some medical tests require an empty stomach.

WHAT TO TAKE

Medical information, though, is the most important thing to bring in any trip to the emergency room, especially in cases where time is critical. The American College of Emergency Physicians recommends people, and especially parents, keep an "emergency file" ready. This file should include insurance cards and lists of medications, chronic conditions, previous operations and all allergies. Recent test results and immunication records are also helpful.

Having a file for each child will be an enormous help if they are in an emergency when under the care of a non-guardian.

"If you have the potential to be giving care (of children), you need to have their medical information," says Butler.

If a medical emergency arises without this information already assembled, Marcy Abernathy, director of the emergency department at Saint Francis Medical Center, recommends gathering your medications in a bag and just bringing them with you. She also suggests, due to the privacy measures hospitals must follow, making a list of people to whom the hospital can release information.