Emergency room or clinic? Three lists, and the order they go in.

The desk gets asked this more than anything else, usually in the first hour: do I go to the hospital or do I call a clinic? The honest answer is that there is a short list where the hospital is the only answer, a longer list where a clinic this week is the right answer, and a gray zone where the answer is both, in order. This file is those three lists.

List one: the emergency room, right now

Chest pain, a sudden severe headache, weakness or numbness on one side, trouble speaking, a loss of bowel or bladder control, or a head injury with vomiting or worsening confusion is an emergency room trip right now, not a call to a clinic.

Add to that: any loss of consciousness, even brief. A seizure. Repeated vomiting. One pupil larger than the other. Slurred speech, unusual behavior, or not recognizing people or places. Severe neck pain with tingling or weakness in the arms or legs. Pain or swelling in the abdomen. Difficulty breathing. A visible deformity. A crash at highway speed with a rollover, an ejection, or a death in another vehicle. Pregnancy plus any impact.

For anything on this list, call 911 or get driven to the nearest emergency department. A chiropractic injury clinic is not the first stop for any of it, and Missouri Injury Clinic is built for planned care, not emergencies. If a clinic sends you to an ER instead of booking you, that is the system working.

List two: the clinic, this week

Neck stiffness and pain, especially the kind that starts on day two. Headache at the base of the skull without any of the list-one features. Low back pain that is worse sitting. Shoulder and chest soreness along the belt line without breathing trouble. Jaw tightness. Fog, irritability, screen sensitivity, or trouble concentrating that started after the crash and does not have list-one features alongside it. Soreness that has not improved after a few days.

These are the symptoms Missouri Injury Clinic's published lanes exist for: auto injuries with diagnosis and a treatment plan, and TBI and concussion rehab. They are not emergencies, and they are also not nothing. The lag file explains why they arrive late, and the getting seen file is the dispatch for the call.

List three: both, in order

A lot of West County crashes land here. You went to the ER the night of the crash, or urgent care the next morning, because something on list one was possible. They checked for the things that kill people, found none of them, and sent you home with a discharge summary that says to follow up. That visit did its job. It did not examine the soft-tissue injury that shows up on day two, because that is not what an emergency department is for.

The follow-up is the clinic. Bring the discharge summary to the exam; it is part of the record and it tells the clinician what has already been ruled out. The ER ruling out a fracture and the clinic examining the strain are two different jobs, and the desk's bulletin is that both of them get done.

The gray cases

The headache that is getting worse. A headache that is steady or improving is a clinic symptom. A headache that is getting worse over hours, especially with vomiting or confusion, is list one. When in doubt, worse means ER.

The kid who seems fine. Teenagers underreport. A young person who is moodier, foggier, or sleeping oddly after a crash, with no list-one features, is a clinic exam this week. Any list-one feature is the ER. The concussion file has the full list.

Numbness and tingling. Tingling that comes and goes in one arm after a neck strain is a clinic exam, and soon. Weakness, or numbness that is constant or on one whole side of the body, is list one.

It was a week ago. If nothing on list one has ever been present, a week-old stiff neck is still a clinic exam. Go and say it was a week ago. Being honest about the timeline is part of the record.

After the ER

Discharge instructions usually say to follow up with a provider. For a crash injury in the clinic's published lanes, that provider can be Missouri Injury Clinic. The near room for West County is Tesson Ferry, (314) 530-5480, open 9 to 6 Monday through Thursday and 9 to 12 Friday, closed 12 to 2. Call in the morning or after two, say it is a crash exam, and bring the discharge paperwork. A documented exam this week protects your health and your options.