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Updated Feb. 14, 2022

Since the COVID-19 pandemic began, concern about possible exposure to the virus has made some patients understandably cautious about visiting the doctor or the emergency department. At UCSF, we've put in place a variety of measures to reduce the risk of COVID-19 transmission, including managing care through virtual visits when appropriate. It's clearly important to protect yourself from COVID-19 by getting vaccinated, wearing masks, thoroughly washing your hands and practicing physical distancing. It's just as important to your health to recognize when you need medical attention in the emergency department.

A number of conditions require immediate care, and our emergency room doctors, nurses and supporting staff members are trained in managing emergencies and saving lives while keeping patients safe. They are ready to act quickly when every second counts. When should you call 911 or make a trip to the ER? We checked in with one of UCSF Health's stellar emergency room physicians, Dr. Jacqueline Nemer, to find out. Here are 12 symptoms that you should never ignore, even during the pandemic:

1. Sudden discomfort in the chest, back or neck

Any pain, discomfort, pressure or squeezing sensation in the chest, back, jaws, neck or along the arms that comes on abruptly or gradually and lasts more than a few minutes, or goes away and comes back, may signal a heart attack or another circulatory emergency.

Not everyone feels a heart attack in the chest. In particular, older adults, women and patients with chronic medical conditions often experience other signs. These may include pain in the jaw, neck or arms; difficulty breathing; light-headedness or dizziness; nausea or indigestion; fatigue; or a cold sweat. Head to the ER if these symptoms are new, last more than a few minutes, or go away and come back.

2. An abrupt change in behavior or function

Several mental and physical symptoms may signal a stroke, seizure or other serious problem. These signs include confusion or sleepiness; loss of coordination, strength, sensation or balance; difficulty speaking; and facial drooping.

3. Light-headedness or fainting

If you experience unexplained fainting, light-headedness, dizziness, balance problems or a sensation that the room is spinning, you need to be evaluated by health care professionals. These symptoms have a wide range of possible causes that can be managed in the ER.

4. Sudden vision loss

Abrupt loss of vision in one or both eyes, with or without pain, could be a sign of stroke, obstructed blood flow to the eye or an urgent problem inside the eye. Timing is critical: The sooner you seek care, the better.

5. Severe headache

Any new intense headache or different type of headache than you've experienced may be signaling a serious problem, such as a stroke, dangerously high blood pressure, an aneurysm (bulge in an artery wall) or other blood vessel problem, or an infection.

6. Severe abdominal pain

When abdominal pain begins gradually and worsens over time or begins suddenly and is intense, it can indicate a number of emergency problems, including appendicitis, pancreatitis, a flare-up of inflammatory bowel disease (IBD), diverticulitis, an intestinal blockage or an infection. Abdominal pain can be particularly concerning if it hasn't occurred before or feels different from pain experienced in the past, and if accompanied by other symptoms, such as fevers, chills, nausea, vomiting, diarrhea, abdominal tenderness, abdominal swelling or bloody stools.

7. Swelling in the face or mouth

Sudden swelling of your face, lips or throat or sudden difficulty swallowing, breathing or speaking may indicate a serious allergic reaction. Even if you have an EpiPen and used it, you should go to the ER immediately after use for evaluation because the condition can worsen quickly.

8. Severe vomiting or diarrhea

Uncontrolled vomiting or diarrhea can quickly lead to severe dehydration and dangerous electrolyte losses, especially if you're losing more liquid than you're taking in. You may require treatment with medications and intravenous fluids.

9. Persistent fever

Fever that doesn't resolve with an over-the-counter fever medication – especially if you're also experiencing pain, rash or any sign of infection – calls for emergency assessment.

10. Worsening rash

A painful rash that worsens quickly may indicate a serious infection.

11. Change in heartbeat

If you suddenly sense that your heart is beating faster or slower than usual, or beating irregularly, and this feeling persists, you should be evaluated in the ER, especially if you also experience light-headedness, dizziness, difficulty breathing or pain.

12. Any new bleeding

If you experience uncontrolled bleeding from your nose, gums or a wound; notice blood in vomit, urine or stool; or see bruising in areas you haven't injured, you should go to the ER. New bleeding must be evaluated by health care professionals, especially if you also have other symptoms, such as light-headedness, dizziness or weakness.