While A&E visits have been increasing, they don't necessarily mean there's an increase in emergency cases in Singapore.

The A&E (Accident and Emergency) departments of public hospitals have been seeing a continuous rise in the number of patients for the past five years – going up by approximately 5.4 per cent or an additional 36,000 visits per annum.

However, the main cause for this increase isn’t a rise in the number of actual emergency cases in Singapore.

On the contrary, based on recent studies conducted at public hospitals including Singapore General Hospital (SGH), more than half of the cases that the A&E sees are for non-emergencies or what hospitals classify as P3 (Priority 3) cases.

Perform a quick assessment of the situation before you head for the nearest emergency department.

“Doing this simple initial step can help save lives as it frees up A&Es of non-emergency cases. Plus, if you have a non-emergency condition and visit a GP instead, you’ll probably get treated sooner,” says Dr Jeremy Wee, Consultant, Department of Emergency Medicine, Singapore General Hospital​ (SGH), a member of the SingHealth​ group.

Here are some basic assessment guidelines regarding common situations so you know when to go to the A&E.

Common medical situations and when you need A&E treatment

Cuts and bruises

A cut or laceration is a break in the skin. The edges of the wound may be straight or jagged, and bleeding can occur if it is deep. However, most small cuts can be treated at home.

Treat at home​Visit Your GP​​Go To The A&E
​​Begin by rinsing the cut under cold running water then clean the wound with a sterile gauze swab. Apply a bandage. If sand particles or wooden splinters are found in the cut. If the cut is deep and bleeding won’t stop.

If an infection develops, causing fever, redness, swelling, pain and pus formation.


If the cut is caused by a rusty object or an animal bite, or a puncture wound.

 

A bruise is caused by hard contact that results in pain and discolouration under the skin. Reddish in colour at first, it progresses to being bluish or purplish, then yellowish before eventually returning to normal skin tones as it heals. This process might take several days to weeks.

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Elevate the bruise to reduce the swelling and apply an ice pack to the affected area for 10mins using pressure.

If signs of infection appear around the bruised region including streaks of redness, pus or other drainage, or fever.

If bruises are caused by blows to the head, followed by loss of consciousness or nausea and vomiting.

Do this every three to four hours for two to three days.


Burns and scalds

You can sustain burns or scalding injuries if your skin comes into contact with hot surfaces or liquids or steam. These injuries have varying degrees of severity. First degree burns are minor, manifesting as redness of the skin (similar to a sun burn). Second degree burns are characterised by blistering. More severe burns will require medical attention at the emergency department.

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For first-degree and second-degree burns on a SMALL area, pour cool water over the injured area for at least 10mins. If burns are infected, leading to a fever, redness or pus formation.If burns occur in the mouth, throat, eyes, ears or genital area, or over the joint surfaces.
Do not use ice, iced water or greasy substances like butter.
If the blistering is causing significant discomfort or pain, or appear large and tense.
​If burns are caused by chemicals, electricity or lightning.
Loosely cover the burn with a sterile gauze bandage or cling wrap. If there are blisters, do not burst them. If third-degree burns are present (skin looks pale, leathery or charred but the affected area is painless).

Take over-the-counter pain relievers to treat the pain.

  

Headaches

Headaches can be due to many causes, ranging from stress, common viral infections and fevers, migraines, to more serious conditions such as intracranial haemorrhage or brain tumours. However, the most common headaches are tension headaches and migraines.

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Take a painkiller like an aspirin (not recommended for children) or ibuprofen.If you suffer from one or more of the following:If you suffer from one or more of the following:
Cool your body down by taking a cold shower and rest.
  • Headaches that last for more than a day even after taking painkillers
  • Frequent headaches
  • Intense, throbbing pain
  • Nausea and vomiting
  • Blurring of vision
  • Stiff neck, numbness or weakness in limbs
  • Slurred speech
  • Fits
  • Altered mental status
  • Worst headache of sudden onset
  • Persistent headache after head injury

Nausea and vomiting

Nausea is the sensation of discomfort with an urge to vomit. While many conditions can cause nausea, it is of concern when it affects your ability to consume and hold down food and liquids, as this can lead to dehydration.

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For nausea:

Drink small amounts of water or sports drinks. Consume light bland food like small pieces of bread if you are able to keep it down.

If vomiting persists for a few hours and you have abdominal pain or diarrhoea. If you have severe abdominal pain or fever.

For vomiting:

Drink small amounts of water or sports drinks. Avoid taking solid food until vomiting has stopped.

 If you exhibit signs of dehydration such as extreme thirst, light headedness and a dry mouth.
  If vomiting is caused by a head injury.

Fever

A fever occurs when a person’s body temperature rises above the normal body temperature of 37°C as a result of an infection, heat injury or dehydration. Other symptoms that accompany a fever include a hot flushed face, headache, loss of appetite, body ache, generalised weakness, shivering or sweating.

While fevers are often due to common viral infections, you should seek medical attention if your symptoms are persistent as fevers from serious bacterial infections will need prompt treatment and evaluation.

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Check your body temperature using a thermometer. For a fever less than 38°C, rest and drink plenty of fluids. You can take paracetamol if you don't have an allergy to it. 

If your fever is 38°C or above, or lasts for more than two to three days.If your fever is persistent and if you are unable to cope with its associated symptoms.
 If you have chronic medical conditions like asthma or diabetes or renal failure, as these patients are at risk of more complicated infections.Do go to the A&E urgently if there is shortness of breath, confusion, productive cough, vomiting or abdominal pain, as this will require further detailed assessment.
 
If you are pregnant.
 
 
If you have recently returned from overseas.
 


R​ead on for more ​common medical situations and when you need to seek A&E treatment​.

Ref: S13