Interview with an ER Doc

An Interview with Dr. med. Don-Felix Ryzek, conducted by Über Mom Jordan Sapir

Social media is this generation’s living and breathing blind-leading-the-blind movement. Under most circumstances it is harmless – well, I wouldn’t call DIY permanent eyebrows “harmless.” Even aside from some botched beauty tips, most of the advice online should be taken with a grain of salt.

Since entering motherhood, I’ve learned a thing or two, most of which I keep to myself. Other than, that is, my often repeated stance on being the most dynamic woman you possibly can, and my inability to stop reposting motivational quotes. Parenting 101 has taught me to never, and I mean never, self-diagnose on Google. The horror! That doesn’t mean that I haven’t frantically searched for all likely ailments to one of my kids rashes, fevers or swellings. Every parent has. We all only want one universal thing as parents: to sleep. No, really, to keep our children safe. No matter how you spin it, judge it, or despise how severe it can be, we all want our children to be kept out of harm’s way. Which leads me to the point of my incessant momplaining: when do we know to worry, plan action and take action?

With summer nearing and travel underway, tarmac workers aren’t the only busy employees . Hospitals, emergency clinics and ERs are on high alert. Summer is unceremoniously deemed “Trauma Season”.

It’s a standard practice for parents to take their children to the Emergency Room in a panicked response to a fever or rash, but the answer I, and presumably other Über Moms, want, is when a visit to the ER is necessary and when can you wait until your pediatrician is available?

When living abroad, these questions become more challenging. Where do I take my child, will they speak English, who do I call, and where do I go?

We’re fortunate enough to have contact with families from all walks of life, who are willing to lend their resources to our organization.

We’ll hear from Dr. med. Don-Felix Ryzek, Über Dad and Über Mom Melissa Ryzek’s husband, on Emergency Room do’s and don’ts, who to call and where to go.

Don-Felix specializes in orthopedics and trauma surgery and works in an Emergency Room in the south east of Munich. He is also certified as a “Notarzt” (emergency physician) and responds to 112 calls during his three or four 24 hour shifts per month.

Follow him on Instagram (@chilldoctorgadget) if you want to gain insight into what his work is like!

Über Mom: I lived in Emergency Rooms for the greater part of my childhood, for sprained ankles, dislocated bones, bloody noses and stitches, so I’m no stranger to long waits and queues. Our family rule was that if it stopped bleeding, wasn’t broken and wasn’t protruding in a grotesque Freddy Krueger way, we’d go to the ER at off-peak hours.

I refer to Emergency Care as the ER by default, but what are the differences here?

Dr. med. Don-Felix Ryzek: Here in Germany, we actually have to differentiate between four different levels of acute treatment.

  • “Ärztliche Bereitschaftspraxis,” most closely resembling what we would call Urgent Care in the US. You can show up at these doctors’ offices (Allgemeinmedizin/ General Practitioner) without appointment with issues that need immediate medical attention. Bring time to wait.
  • “KVB-Notdienst” can be reached via the national phone number 116117. It is similar in staffing to the “Ärztliche Bereitschaftspraxis,” however, these physicians will come to your house. Call here for issues that require immediate medical attention and you are not able to manage getting to a “Bereitschaftspraxis” by yourself.
  • “Nothilfe/Notaufnahme” (Emergency Room): come here for issues that are life or limb threatening, as we call them. If you can manage to come here by yourself (have a friend or family member drive you, take a taxi) please do so.
  • “Rettungsdienst”, can be reached Europe wide via 112. Call here for life or limb threatening emergencies where time is of the essence and coming to the ER by yourself is not an option or would greatly increase danger for the patient or others involved (other traffic participants for example, if you’re driving erratically). Medical personnel will arrive typically within minutes, take care of imminent issues and transport you to an appropriate ER.

Über Mom: Is there a rule of thumb for when to visit the ER in Germany?

Dr. med. Don-Felix Ryzek: Like I mentioned, the ER is for life and limb threatening injuries. Typical reasons for visits include

  • Severe chest pain
  • Severe abdominal pain
  • Shortness of breath
  • Allergic reactions (new symptoms)
  • Neurological symptoms: dizziness, loss of consciousness, seizures
  • Fluids uncontrollably leaving your body (blood, vomit or stool)
  • Something is sticking out of your body that shouldn’t be (bone) or something is sticking into your body that shouldn’t be (use your imagination or google images for details…)
  • One of your body parts looks like it shouldn’t (severe swelling, distorted) or you experience loss of function of any of your body parts
  • One body part is missing. Please make sure to bring the missing body part along. Do not soak the missing body part in any fluids. It’s probably ok to call 112 and have them take you and make sure the severed body part is packaged correctly.

Über Mom: I had the unfortunate experience, as many parents do, of having a child with a severe head concussion. When it happened, my partner and I didn’t skip a beat, we knew when she vomited that it was straight to the hospital. I’ll give you an incident and you tell me if it can wait or head straight for the gate.

Dr. med. Don-Felix Ryzek: I’ll answer all of these as well as I can, but a lot of them require either more information or simply some common sense (which I realize is hard to come by when you’re alone with a screaming child and you’re not sure what to do).

Fever over 39,5: Everyone who has young children knows that fevers are quite common. You don’t want to traumatize the kid and yourself with an ER visit every time the thermometer reads 39,5. If the fever is controllable, i.e. if you can lower it yourself with remedies accessible to you (Paracetamol, Ibuprofen, cold wraps etc) and your child still pees, eats and drinks, you can wait it out. The next step would actually be to consult your pediatrician or a Bereitschaftspraxis. Only if those cannot help or refer you on should you go to the ER. If you have an infant or your kid doesn’t pee or is lethargic, by all means, head to the ER immediately.

Fever lasting four consecutive days over 39,5: In this scenario, an ER visit is optional, but medical treatment is not. You should most definitely consult your pediatrician or if not available a pediatric ER.

Head injury from falling off the sofa: It’s important to know what will happen if you go to an ER with a possible head trauma. The patient and the mechanism of injury are assessed and if there is ANY risk of the fall having resulted in an “intracranial injury,” meaning an injury close to or inside of the brain, a CT scan and/or 48 hour inpatient monitoring will be the result. If you’re sitting on a sofa and fall off it, you should come into the ER, something is definitely wrong with you 😂. Joking aside, if the fall resulted in a head bleed and we follow the rules of thumb we talked about earlier, it’s a trip to the ER. The same with neurological symptoms (vomiting in this case is a symptom of increased pressure on your brain, so it counts). With newborns I’d be a little more generous with a visit to the ER as well.

Head injury from falling from over 2 meters: Definitely come in. Typically this scenario is less of a “oh, should I go to the ER or not” scenario but rather a “should I call 112 or not” scenario. Falls from that height onto the head are likely to produce unconscious people who need to be immobilized for transport. It’s important however that falling from a tree onto your feet, then knees, then hands and then touching your head to the ground a little rougher is not a head injury falling from over 2 meters… but when in doubt come in, especially since chances are, something else is damaged then.

Ingestion of known cleaning products: Call the poison hotline. 089 19240.

Ingestion of unknown cleaning products: Call the poison hotline. 089 19240. You can call them for ingestion of anything worrisome.

Full body rash: if it developed quickly and is itchy, I would actually call 112. A rash can be an indicator for an allergic reaction which can quickly cause respiratory issues as well. You want trained people there and ready to deal with that issue up front rather than calling 112 saying, “I have a patient that is barely breathing”. I would also get immediate help if the rash developed after contact with a specific substance. Aside from these cases, it’s reasonable to wait and monitor the rash and/or consult your pediatrician. Even if it’s a few hours before the office opens.

Rash that is patterned and accompanied with a fever: Here we have two overlapping symptoms. Technically, a rash can occur on its own just with a high fever. In that case, the “fever rules” I mentioned earlier apply. Can you lower the fever at home? Does that limit the rash or reduce it? If so, have your pediatrician take care of it.

Sprained ankle: Main issue: it appears that people NEVER know when they have just a sprained ankle. Sprained ankles are one of the most common unnecessary visits to the ER since they only require rest, ice, and some elevation. A broken ankle, on the other hand, is very much is a reason to go to an ER. So how can YOU tell the difference? If there is no pain when pushing on the outside of your foot or about a handwidth below your knee on the outside of your calf, AND you can walk on your own (limping is still walking! Wait for ten minutes or so after the injury before you try; often times people are surprised at how well they can walk after the initial shock has subsided), you’re pretty much guaranteed to not have a fracture. In this case (known as the Ottawa Ankle Rule) we wouldn’t even do an X-ray…

Visibly broken ankle: First off: a swollen ankle does not equate a fracture, necessarily. A visibly broken ankle means either the ankle is deformed (your foot is pointing the wrong direction) or bone is protruding. If we follow the rules of when to visit an ER that we talked about earlier, we have a clear indication to go to one in this case. I would actually go one step further. Call 112. You’ll likely be in so much pain that you will require strong pain meds.

Open wound: An open wound is really anything between a scratch and a blood gushing crater, so I’d say some common sense is in order here. Can you cover it with a bandaid or a bandage from your home first aid kit (maybe we’ll talk about those some other time…?)? If you can’t get the bleeding to stop on your own, go to the ER. Some extra info: we have a time window of about 6 hours to close a wound surgically, after that the infection risk is too high and we will have to leave the wound open anyways. So if it needs stitches, you might as well come right away.

Open wound that persistently bleeds after a given amount of time: See the ER rules we established.

Sunburn: Depends on the degree of the burn and the area burnt. Please use common sense. Most people have had sunburns before. If it’s a “regular” sunburn, go to a drugstore or pharmacy and buy some ointment. If there are burn blisters, get them looked at. A “Hausarzt,” pediatrician or Bereitschaftspraxis will be able to help you out.

Fire burn: A burn is a burn is a burn. Same rules as for the sunburn apply. Having inhaled excess amounts of smoke is another story. If that’s the case, call 112.

Choking: Unless you can reach an ER within 5 minutes, call 112.

Eye infections: Urgent care Hausarzt or pediatrician can handle these.

Ear infections: Urgent care Hausarzt or pediatrician can handle these.

Über Mom: What are the most common reasons for visits to the ER during the summer? Are there any you can warn against?

Dr. med. Don-Felix Ryzek: We often have people showing up with ticks. As worrisome as ticks are, they do not need to be removed in an ER. People can do it themselves or go to a Bereitschaftspraxis. Tools for tick removal can be purchased at any pharmacy. The only time we do more than simply removing the tick is when we see a large concentric red area around the bite. Also: get your FSME vaccination!

Über Mom: In a panicked haze, I’m certain it’s common to forget the essential paperwork, only to arrive at the hospital empty-handed. Should parents have an ER kit ready?

Dr. med. Don-Felix Ryzek: Great question! The minimum you should know or have available are lists of your allergies, the medical conditions you have and which medications you take for them. Vaccination records and emergency phone contact would also be helpful. When I say a list of the medications, I mean detailed, with dosage and how often you take it. It doesn’t help me if you tell me you take that blue blood pressure medication twice per day. My suggestion: There are tons of apps these days that allow you to easily carry all that information on your smartphone without having to know it. iOS for instance allows you to put a lot of the relevant medical information in the “Health” app. Added benefit: in case you were to have an accident or a medical issue that renders you incapable of giving relevant information to us, we can access this information on your phone without knowing the code! This is extremely valuable.

Über Mom: Emergency rooms are costly and need to be reserved for people who are in imminent danger. What can we be mindful of to ease the workload of the doctors and nurses who care for us?

Dr. med. Don-Felix Ryzek: Follow the guidelines I mentioned above about when to come and when not to. Don’t be rude. If you have to wait, chances are it’s because there are patients with medical issues worse than yours. What drives us crazy is hearing “Oh, I’ve had this issue for x weeks and now (Friday afternoon) I really need this taken care of, and my doctor is not in the office”. Don’t be one of those people. Ask yourself whether you really need to have something looked at at 3am or whether it can wait until regular business hours. Being awoken in the middle of the night for a stiff neck or back pain is pretty frustrating.

Über Mom: What are the most common summer injuries?

Dr. med. Don-Felix Ryzek: Anything related to falling off a bike seems to be pretty popular during the summer months.

Über Mom: Where can parents find the resources for emergencies for minors?

Dr. med. Don-Felix Ryzek: I think anyone should take a first aid course regularly, especially people with kids. They have first aid courses specific for parents. IF used wisely, the internet is a great resource. But once you get to the point where you have to go to a hospital, there are four hospitals in the Munich area that have a pediatric ER. You can find them under this link:

Pediatric Hospitals

Über Mom: What is a common avoidable injury seen on a regular basis in the ER?

Dr. med. Don-Felix Ryzek: Any type of open head injury that needs stitches after falling off a bike. Wear a bike helmet. Any injury that happens after saying “Challenge accepted” or “Hold my drink” probably could have been avoided as well…

Über Mom: How can parents avoid the Emergency Room this summer?

Dr. med. Don-Felix Ryzek: As an ER doc and a parent, I’d have to say you just can’t. Beyond common sense precautions (don’t run into traffic, don’t juggle knives, don’t try and fit multiple people on a bike…) getting injured is a side effect of life. I guess you can also avoid the ER by not going… I gave you the tools to decide when you should and when you can stay home.

Über Moms would like to thank Dr. med. Don-Felix Ryzek for granting us this interview and for all his great advice. Here’s to none of us needing to visit the ER this summer – wear your helmets!

 

 

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Jordan Sapir, mother of two glitter-laden girls, 2 and 5, studied Journalism and International Political Science in NYC, a place she once called home. She can slaughter five languages fluently. She has worked in a newsroom or two, walked a catwalk or three, and is all for an impromptu adventure. Having traded in her Prada for pretzels, the founder of Über Moms lives in Munich, where she is a stay at home mom and studying to become a certified nutritionist. She is a mommy on a mission and wants to help fellow mothers raise healthy happy families, and beat a PR here and there.

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