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Corner Clinic

This month we discuss when to go to urgent care, what’s considered a low-risk birth and how to know if you need an EpiPen

By UC San Diego Health Experts   |   October 28, 2016
  1. When should I go to urgent care instead of the emergency room?
  2. What is considered a low-risk birth?
  3. Do I need an EpiPen?
James Killeen

When should I go to urgent care instead of the emergency room?

James Killeen, MD, emergency physician at UC San Diego Health

Urgent care offers treatment to patients of all ages for minor injuries and illnesses, like the flu, mild asthma attacks, broken bones and sprains, cuts requiring stitches and more, providing you a one-stop option for unscheduled, time-sensitive care. Life-threatening emergencies, such as a heart attack or a serious head injury, require a visit to the emergency department or ED (also commonly referred to as the emergency room (ER) at hospitals).

Urgent care offers a convenient option when someone's regular physician is on vacation or unable to offer a timely appointment. When a minor illness strikes outside of regular office hours, urgent care offers an alternative to waiting for hours in a hospital emergency room. Urgent care does not replace your primary care physician, however, an urgent care provider can fully care for most minor illnesses and injuries, either independently or in consultation with another specialist. Sometimes patients will require follow-up with or referral to another specialist or transfer to an emergency department. Urgent care providers do not perform surgery (other than wound repair and skin lesion removal), do not care for inpatients and typically do not engage in the ongoing medical care of chronic medical problems.

If you receive your regular care at UC San Diego Health, the urgent care staff will be able to access your medical record. In addition, x-ray and laboratory services are available at our urgent care site. At UC San Diego Health, our attention to detail is in our DNA and our core mission activities — teaching, research and clinical excellence, commitment to patient care and satisfaction ensure that patients with urgent medical needs receive the best medical expertise days, evenings, and weekends.

What is considered an emergency?

Urgent care is not a substitute for emergency care. In general, an emergency condition is one that can permanently impair or endanger the life of an individual. Some examples of conditions that require emergency medical care include:

  • Severe chest pain or difficulty breathing
  • Compound fracture (bone protrudes through skin)
  • Convulsions, seizures or loss of consciousness
  • Fever in newborn (less than 3 months old)
  • Heavy, uncontrollable bleeding
  • Deep knife wounds or gunshot wounds
  • Moderate to severe burns
  • Poisoning
  • Serious head, neck or back injury
  • Pregnancy-related problems
  • Severe abdominal pain
  • Signs of a heart attack (example: chest pain lasting longer than two minutes)
  • Signs of a stroke (example: loss of vision, sudden numbness, weakness, slurred speech or confusion)
  • Suicidal or homicidal thoughts

Dial 911 immediately for any medical problem that appears to be life-threatening. Proper care will be provided at the closest ED. Remember, ED visits should be reserved for true emergencies, such as chest pain and severe injuries.

What is considered an urgent medical condition?

Urgent medical conditions are ones that are not considered emergencies but still require care within 24 hours. Some examples of such conditions include:

  • Accidents and falls
  • Sprains and strains
  • Moderate back problems
  • Breathing difficulties (example: mild to moderate asthma)
  • Bleeding/cuts — not bleeding a lot but requiring stitches
  • Diagnostic services, including X-rays and laboratory tests
  • Eye irritation and redness
  • Fever or flu
  • Vomiting, diarrhea or dehydration
  • Severe sore throat or cough
  • Minor broken bones and fractures (example: fingers, toes)
  • Skin rashes and infections
  • Urinary tract infections

Seemingly small injuries and illnesses will be examined by our urgent care physicians. If greater care is needed, our staff will direct patients to the proper health care provider, or if it is a true emergency, we will transfer patients directly to a hospital emergency room for further treatment.

UC San Diego Health urgent care providers care for patients of all ages. Our providers have expertise evaluating and treating patients using an onsite X-ray and simple office-based laboratory tests, such as urinalysis, pregnancy test or a rapid strep assay. Due to the simpler administrative procedures and costs associated with office-based versus hospital-based practice, similar care in our urgent care can generally be provided more quickly and economically than in an emergency room setting.

Those who require more extensive laboratory testing or advanced imaging, like CT scanning and ultrasound, will be directed to an appropriate site for such testing or transferred to a hospital ED as needed.

Learn more about UC San Diego Health’s emergency services and urgent care, including locations.

Gina Frugoni

What is considered a low-risk birth?

Gina Frugoni, MD, obstetrician/gynecologist at UC San Diego Health

Pregnancy is a time of many changes in a woman's body. The physiologic changes with pregnancy, labor and delivery and lactation are phenomenal to watch and experience. Many of these changes are normal and healthy, but unfortunately there are a subset of pregnancies with problems that can place mothers and their babies at high risk. 

There are many issues that can come up in a pregnancy. Pre-existing medical conditions, such as diabetes, high blood pressure and obesity have become more common in women of reproductive age, and when a woman gets pregnant, these medical conditions can place both the mother and fetus at risk.  Even when a woman is perfectly healthy, there are medical conditions that can affect the placenta or the fetus. Birth defects, problems with nutrient transfer across the placenta, fetal growth and even breech positioning can put the baby at risk. Some of these conditions require an elevated level of care with specialized obstetricians or neonatologists.

A low risk birth is usually a result of a non-obese mother with no significant medical problems or prior uterine surgery, including cesareans, who receives regular prenatal care and is carrying a single baby in the head down position past 37 weeks of gestation. 

These women are predicted to need less interventions, can deliver in lower risk environments and have better outcomes than women with more complicated pregnancies.

UC San Diego Health provides access to all the resources a woman and her infant may need both during the pregnancy and after delivery while still encouraging women to have elements of their desired birth experience. The goal is always for a healthy mom and baby.

UC San Diego Health Birth Center Eligibility

Olga Rose

Do I need an EpiPen?

Olga Rose, MD, pediatrician at UC San Diego Health

It is very important for children with severe allergic reactions, also known as anaphylaxis, to have ready access to an epinephrine auto-injector (EpiPen) at all times. Anaphylaxis is most commonly caused by foods, medicines, latex, insect bites or a variety of other less common triggers. Not everyone affected by anaphylaxis will have the same signs, but common symptoms include hives, flushing, swelling of the lips and tongue, tightness of the throat, difficulty breathing, vomiting and dizziness after contact with an allergen. If a child has symptoms of anaphylaxis, epinephrine should be administered immediately — it can be life-saving. While medicines such as anti-histamines (example: Benadryl or Claritin) and steroids can be helpful adjuncts in treating allergic reactions, they have slow onset of action and are no substitute for epinephrine in case of an anaphylactic reaction.

Children with severe allergies, as well as their parents and caregivers, should familiarize themselves with proper use of the auto-injector ahead of time, in case they ever need to use it. The EpiPen website provides a helpful tutorial about the proper use and manufacturers provide practice auto-injectors (without needles) that can be used for training.

To use the auto-injector, you remove it from its case, take off the safety caps and stick the tip of the auto-injector firmly in the child’s outer thigh. Hold it in place and count to 10. The needle of the auto-injector can go through clothes — don’t waste time taking clothes off in an emergency situation. After you use the auto-injector, seek immediate medical attention by calling 911 or going to the hospital as the symptoms can return once the epinephrine wears off. Epinephrine auto-injectors typically come in sets of two in case the symptoms return before reaching the hospital or if there is no improvement in symptoms after the first dose. Common side effects of epinephrine include rapid or pounding heartbeat, nervousness, trembling, nausea and dry mouth. These symptoms typically resolve over the course of a few hours.

Auto-injectors should be replaced once they have expired because the epinephrine will not be as effective in case of an emergency. The epinephrine cartridge window should be examined periodically to ensure that the solution is colorless and contains no floating particles. Epinephrine should be stored at room temperature, away from extreme cold or heat.

I think it is of paramount importance for children with severe allergies to have ready access to an epinephrine auto-injector at all times. It can save a child’s life and you don’t know that you will need it until you do! To learn more, please make an appointment with me or one of my colleagues — our pediatrics group is in a new convenient location at 8910 Villa La Jolla Drive, in the UTC region of La Jolla.

To learn more about the featured medical specialties, please visit:

Allergy and Immunology

Emergency and Urgent Care

Pregnancy and Birth Care