The ER Survival Guide
What Nurses Wish You Knew
Charles T. Folsom Jr., RN
Emergency Room Nurse · Healthcare Executive · Doctoral Candidate
Founder, IAMNURSE LLC · 37+ Years in Emergency Medicine
IAMNURSE LLC · Atlanta, Georgia · 2026
Important Disclaimer
This guide is for general educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, nurse practitioner, or other qualified health provider with any questions you have regarding a medical condition.
If you or someone you know is experiencing a medical emergency, call 911 immediately. Do not use this guide to delay seeking emergency care.
The clinical information in this guide is based on the author's 37+ years of emergency medicine experience and current general medical knowledge. Individual situations vary. When in doubt, seek professional medical evaluation.
For mental health crises, contact the 988 Suicide & Crisis Lifeline by calling or texting 988.
© 2026 IAMNURSE LLC. All rights reserved.
3355 Lenox Rd NE, Suite 750, Atlanta, GA 30326 · hello@iamnurse.org · (866) 730-0492
Table of Contents
Introduction
—Why This Guide Exists
Part 1 — When to Go
1aCall 911 Immediately
Life-threatening emergencies that cannot wait
1bGo to the ER (Not Immediate, But Urgent)
1cTry Urgent Care Instead
1dStay Home and Monitor
Part 2 — How to Get Better Care
2The ER Triage System Explained
How urgency is assessed and what to say to get prioritized
Part 3 — What to Expect
3Step-by-Step: What Happens in the ER
Triage → waiting room → bed → tests → results → discharge
Part 4 — Common Scenarios
4Chest Pain · Abdominal Pain · Difficulty Breathing · Fever
Parts 5–9 — Everything Else
5How to Speed Up Your Visit
6Red Flags After You Go Home
78 Questions to Ask Before Discharge
8Common ER Frustrations Explained
9Managing Chronic Conditions to Avoid the ER
Appendix
—Quick Reference Card — Print & Keep
This guide teaches you five things:
- When the ER is actually necessary
- How to get seen faster and receive better care
- What to say so doctors and nurses understand your problem
- Red flag symptoms that demand immediate attention
- What to bring and how to prepare
If you read one health guide this year, make it this one. Because one day, you or someone you love will need the ER. And knowing how it works could change the outcome.
Always remember
When in doubt — go. This guide helps you make smarter decisions, but it never replaces your instincts. If something feels seriously wrong, seek care immediately. No guide is worth your life.
🚨 Call 911 Immediately — Do Not Drive Yourself
Chest Pain or Pressure
- Squeezing, pressure, or heaviness in the chest
- Pain radiating to arm, jaw, neck, or back
- Accompanied by shortness of breath, nausea, or sweating
Difficulty Breathing
- Gasping or struggling for air
- Wheezing or high-pitched breathing sounds
- Pale, blue, or gray lips or fingertips
Stroke Symptoms (Act FAST)
- Face drooping on one side
- Arm weakness — one arm drifts down
- Speech slurred or unable to speak
- Time — call 911 immediately
- Also: sudden vision loss, severe sudden headache unlike any before
Other 911 Emergencies
- Severe bleeding that won't stop after 10–15 minutes of direct pressure
- Severe allergic reaction (swelling of lips/tongue/throat, difficulty breathing)
- Suspected poisoning or overdose — call Poison Control: 1-800-222-1222
- Loss of consciousness
- Severe trauma (fall from height, high-speed collision, major impact)
- Signs of sepsis: fever + confusion, rapid breathing, extreme weakness, or disproportionate pain
🏥 Go to the ER — Urgent But Not an Emergency
- Fever 103°F+ in adults with severe body aches, or any fever in babies under 3 months
- Fever with stiff neck (possible meningitis)
- Fever with a rash that doesn't disappear when pressed
- Suspected broken bones, deep cuts needing stitches, eye injuries
- Complete inability to urinate with bladder pain
- Blood in urine with severe pain (suspected kidney stone + fever)
- Severe pain that came on suddenly and limits your ability to function
- Persistent vomiting — can't keep any fluids down for 4+ hours
- Mental health crisis: suicidal thoughts with a plan, psychosis, severe inability to function
- Uncontrolled blood sugar (extremely high or low)
- Asthma attack not responding to inhaler
- Blood pressure causing symptoms (headache, chest pain, vision changes)
⚡ Try Urgent Care Instead — Save the ER for Emergencies
Urgent care handles most non-life-threatening conditions faster and at a fraction of the ER cost.
- Minor cuts (less than ¼ inch, not deep), minor burns, broken toenail
- Suspected sprains or minor strains, broken toes
- Ear infection, sore throat without difficulty swallowing, UTI symptoms
- Skin infections (small abscess, minor cellulitis)
- Fever under 103°F without severe symptoms, general cold/flu
- Moderate headache, mild-to-moderate back pain, muscle aches
- Mild rash without fever, mild allergic reaction
🏠 Stay Home and Monitor
- Mild sore throat, mild headache (not sudden or severe)
- Mild nausea or upset stomach for less than 2 hours
- Mild cough without fever
- Mild diarrhea (1–2 episodes)
At home: stay hydrated, rest, use OTC pain relief (acetaminophen or ibuprofen). Call your doctor if symptoms persist 3+ days, worsen, or you develop new symptoms.
The ER Triage System
When you arrive, you'll be triaged — assessed for urgency. This determines your wait time. Triage is based on severity, not arrival order.
1
Emergent
Seen immediately
Life-threatening, severe pain or trauma
2
Urgent
10–15 minutes
Chest pain, difficulty breathing, moderate trauma
3
Semi-Urgent
1–2 hours
Moderate pain, injury needing evaluation
4
Non-Urgent
2–4 hours
Mild symptoms, could've been urgent care
How to Communicate with ER Staff
✓ What Works
- "I have chest pain with shortness of breath" — clear, specific
- "The pain started suddenly at 2 PM and hasn't gone away" — give a timeline
- "This is different from any pain I've ever had" — context matters
- "I'm on [medication] and allergic to [drug]" — critical safety info
- If you're in severe pain: say so directly — "I'm in severe pain"
- If you think it's a stroke: say "I think I'm having a stroke"
✗ What Doesn't Work
- "I don't feel good" — too vague to triage properly
- Listing 10 different complaints — we need to focus on the most urgent one
- Downplaying: "It's probably nothing, but..." — tell us the severity, let us decide
- Not mentioning medications or allergies until asked — this is safety-critical
The One Question Every Patient Should Ask
"What tests are you ordering for me?"
Listen to the answer. If you don't understand, ask again. This one question keeps you informed and shows the team you're engaged in your care.
The Step-by-Step Process
- Triage desk — Vital signs (blood pressure, heart rate, temperature, oxygen), brief history, main complaint. This takes 3–5 minutes.
- Waiting room — You wait for a bed. This is normal. How long depends entirely on volume and how sick others are.
- Bed/Room — A nurse takes your full history, starts an IV if needed, and begins initial care.
- Doctor or NP visit — Usually 5–15 minutes depending on complexity. This is your window — be concise and specific.
- Tests — Blood work, X-rays, EKG, ultrasound, CT scan as ordered. You may wait for results.
- Results and plan — Treatment, medication, observation, or discharge with instructions.
Tests You Might Get
Blood Work (CBC, CMP, Cardiac Markers)
Checks for infection, electrolyte imbalance, kidney/liver function, heart damage. Don't worry if they take multiple vials — they're running different panels.
EKG (Electrocardiogram)
Checks heart rhythm and electrical activity. Painless, takes about 1 minute. Common for chest pain, shortness of breath, or palpitations.
Chest X-ray
Checks for pneumonia, fluid in lungs, collapsed lung, cardiac enlargement. Fast and safe.
Ultrasound
Looks at organs — abdomen, pelvis, kidneys, gallbladder, blood vessels. Safe, no radiation.
CT Scan
Detailed cross-sectional imaging of head, chest, or abdomen. Uses radiation, so doctors order it when the benefit outweighs the risk. Common for head injuries, severe abdominal pain.
Urinalysis
Tests urine for infection, protein, blood, kidney function. Quick and often done automatically.
Scenario 1: Chest Pain
What Happens
- Immediate EKG (within 10 minutes of arrival)
- Blood tests for cardiac markers (troponin)
- Serial EKGs over time to catch changes
- Chest X-ray
- Doctor evaluation
What You Can Do
- Don't minimize: "It's probably anxiety" delays care
- Describe the pain: sharp, pressure, squeezing, radiating
- Mention all associated symptoms — nausea, sweating, shortness of breath
- Give a clear timeline of when it started
Scenario 2: Abdominal Pain
What Happens
- Physical exam (pressing on abdomen)
- Blood tests and urinalysis
- Ultrasound or CT scan to visualize organs
- Doctor evaluation and pain management
What You Can Do
- Point to the exact location of pain
- Describe: sharp, dull, cramping, constant, or intermittent
- Note what makes it better or worse
- Mention recent diet, bowel changes, or injuries
Scenario 3: Difficulty Breathing
What Happens
- Oxygen saturation check immediately
- Supplemental oxygen if levels are low
- Chest X-ray and EKG
- Blood tests (arterial blood gas if severe)
What You Can Do
- Be clear about onset — sudden vs. gradual
- Mention any triggers: exercise, allergen, new medication
- Describe associated symptoms: wheezing, chest pain, fever
- If you have asthma or COPD, bring your inhalers
Scenario 4: Fever with Other Symptoms
What Happens
- Blood cultures if serious infection is suspected
- Urinalysis, blood work
- Chest X-ray if respiratory symptoms are present
- Spinal tap if meningitis is suspected
What You Can Do
- Report your actual temperature — not just "I felt hot"
- Mention all symptoms: headache, neck stiffness, rash
- List recent exposures: sick contact, travel, unusual food
- Note if you're immunocompromised or on steroids
Before You Arrive
- Call ahead if possible — "I'm coming in for chest pain" helps them prepare a room
- Bring your ID and insurance card
- Bring a list of current medications — or the actual bottles
- Write down your allergy information — drug allergies especially
- Bring someone with you — they can advocate for you when you're in pain
While You're There
- Lead with your main complaint — not your entire medical history
- Ask questions — "What test is this? What will it show?"
- Report all symptoms — even ones that seem unrelated
- Mention all medications — including OTC drugs, supplements, and herbal remedies
- Tell us about previous reactions — to medications, procedures, contrast dye
- If you're in severe pain, say so — ask for pain management early, don't suffer in silence
- Ask about the timeline — "How long until results?" helps you manage expectations
⚠️ Return to the ER Immediately If You Experience:
- Chest pain returns or worsens
- Difficulty breathing develops or worsens
- Fever worsens despite medication, or new fever develops
- Vomiting continues and you can't keep any fluids down
- Severe abdominal pain returns or intensifies
- Wound shows signs of infection — increasing redness, warmth, swelling, pus, or red streaks
- Confusion, difficulty concentrating, or altered mental status
- Severe headache that wasn't there before
- Pain not improving with prescribed medication
- Any symptom that frightens you — trust your instincts
The ER gave you a diagnosis based on the information available at that time. Conditions evolve. If something changes or worsens, returning is not an overreaction — it's the right call.
Ask These Before You Walk Out
- "What did you find?" — Ask for a specific answer, not vague reassurance.
- "Why am I getting this medication?" — Know what each prescription does.
- "What should I do if the pain or symptoms come back?"
- "When should I follow up with my primary care doctor?" — Get an actual timeline.
- "Are there any restrictions on my activity?" — Work, exercise, driving, lifting.
- "What specific symptoms should bring me back to the ER?"
- "What should I monitor at home?"
- "Do I need any follow-up tests?" — Some results take days to finalize.
If a doctor or nurse seems rushed, say: "I just have a couple quick questions before I go." You have the right to understand your own care.
"Why is the wait so long?"
ER wait times are based on severity, not arrival order. Someone who came in 2 minutes after you with chest pain will be seen first. That's not unfair — that's the system working correctly. If you've been waiting a long time, it usually means others were sicker.
"Why does it take so long to get test results?"
Lab work takes time to process. Blood cultures need hours to grow. CT scan queues serve the entire hospital. The test you need isn't the only one running. Pushing for faster results doesn't speed up chemistry.
"Why was I discharged so quickly?"
If your tests are normal and your symptoms are resolving, keeping you longer doesn't change the outcome. Hospitals aren't hotels. But if you're still concerned, you have the right to ask for a second opinion or request additional evaluation before leaving.
"Why couldn't they figure out what was wrong?"
Sometimes multiple tests come back normal — and that actually means something. It rules out serious disease. Some diagnoses aren't obvious in a single ER visit. Sometimes you need follow-up with a specialist. Medicine is not always clear-cut, and the ER's job is to rule out what's life-threatening, not always to identify every diagnosis.
Establish a Primary Care Doctor
- See them at least annually — build a relationship so they know your baseline
- Get referrals to specialists when needed — don't let conditions go unmanaged
- Be honest about symptoms — the ER treats crises, your PCP prevents them
Manage Your Chronic Conditions Daily
- Take medications exactly as prescribed — skipping doses causes the crises that land people in the ER
- Monitor blood sugar if diabetic — uncontrolled blood sugar is a leading ER driver
- Monitor blood pressure if hypertensive — a BP crisis can cause strokes
- Get seasonal flu shots — flu triggers hospitalizations in high-risk patients
- Manage stress — it's not soft advice, it's clinical
Pay Attention to Early Warning Signs
- Increased frequency of your usual symptoms
- Worsening of your baseline condition
- New symptoms appearing alongside existing ones
These warrant a doctor's visit — not an ER visit. Catching problems early keeps them from becoming emergencies.
Use Urgent Care Appropriately
Strep throat, UTI, ear infection, sprain, minor infection — these are urgent care. Using the ER for these adds to wait times for everyone and costs you significantly more. Urgent care handles them faster and cheaper.
I've seen thousands of patients in the ER over 37 years. The ones who got the best outcomes were those who:
- Knew when to come in — not too early, not too late
- Communicated clearly — specific about symptoms, timeline, and medications
- Advocated for themselves — asked questions, didn't accept vague answers
- Had someone with them — support and a second set of ears matters
- Followed up — got specialist care, managed their chronic conditions
The ER is for emergencies. Use it that way. But when you need it, don't hesitate. And when you're there, be your own best advocate.
"Your body is trying to tell you something. Learn to listen."
— Nurse Charles, Charles T. Folsom Jr., RN
Follow Nurse Charles on TikTok @1nursecharles for ongoing ER truths, myth-busting, and health education straight from the floor.
Visit iamnurse.org for more resources.
🚨 Call 911 For:
- Chest pain or pressure
- Difficulty breathing
- Stroke symptoms (FAST)
- Severe bleeding
- Severe allergic reaction
- Loss of consciousness
- Sepsis (fever + confusion)
- Severe trauma
🏥 Go to the ER For:
- High fever with severe symptoms
- Suspected broken bones
- Deep cuts needing stitches
- Mental health crisis
- Uncontrolled chronic disease
- Persistent vomiting/dehydration
- Sudden severe pain
⚡ Try Urgent Care For:
- Minor cuts, burns, sprains
- Ear/throat/UTI infections
- Cold/flu symptoms
- Mild rash or allergic reaction
- Moderate pain
🏠 Stay Home For:
- Mild sore throat or headache
- Mild nausea (<2 hours)
- Mild cough without fever
- 1–2 episodes mild diarrhea
Emergency Numbers
911 — Medical Emergency ·
988 — Suicide & Crisis Lifeline ·
1-800-222-1222 — Poison Control