Trucker M.D.

By John McElligott, MD
with Jeffrey Heinrich, Ed.D., PA-C


Deciding when to seek emergency medical care is a tough question for everyone – especially professional truck drivers far from home and on an unforgiving time schedule. When should you find the nearest emergency room pronto? It’s a complicated judgment call.

Here are my top 10 “red flag” reasons to pull over and seek emergency care.

  1. Sudden loss of vision in one eye, either complete or partial. This red flag is especially important for people with diabetes who are prone to bleeding because of elevated or uncontrolled blood sugar.

  2. Severe pain in one or both eyes with tunnel vision – i.e., central, straight-ahead vision.

  3. Thunderclap headache, or “The worst headache I have ever had.” This statement by anyone is a red flag for urgent care now. This type of headache in drivers with high blood pressure can be the beginning of the end.

  4. Sudden onset of dizziness with associated symptoms of weakness in the face or arm and leg, which may be accompanied by speech difficulty.

  5. Sudden onset of shortness of breath with or without sweating. Shortness of breath associated with (or without) a painful leg can be the first sign of a pulmonary embolism (blood clot from the leg to the lungs). This symptom could also be a warning of other conditions, such as cancer or hereditary clotting problems.

  6. Fever with productive cough and shortness of breath, especially when associated with extreme fatigue. Flu season (November through March) is the time when influenza followed by pneumonia is especially deadly. You’ll need immediate care.

  7. Chest pain described as pressure in the center of the chest with or without sweating and shortness of breath. The pain may radiate to the jaw, left arm or upper middle of your back.
    People with diabetes will have no pain in 50 percent of acute coronary syndrome (ACS) cases and may have symptoms of fatigue, shortness of breath, and edema of the extremities extending up the entire body with fluid buildup in the lungs. These are all symptoms of the heart (a pump) failing. Keep in mind the only symptom for ACS may be profound fatigue.
    The most common risk factor for all the above is smoking and family history.

  8. Abdominal pain that has a sensation of tearing and that radiates to the back with or without fever. Abdominal pain that is intense and suddenly resolved followed by fever and loss of appetite, especially with resumption of the pain in any of the four quadrants of the abdomen. Abdominal pain that is associated with a previous history of poor circulation, cramping in the buttocks when walking, or bluish color to the toes and feet. Persistent abdominal pain with nausea and vomiting in a diabetic person always needs to be seen ASAP.
    Women who experience abdominal pain and unusual, severe bleeding (using more than four tampons/sanitary pads in the course of a few hours) should be examined.

  9. Acute groin pain with swelling of the scrotum in men and/or a bulge in the groin area in a female or a male driver. If the bulge is persistent and painful, seek help. It could be a torsion of the testicle in men, or a strangulated hernia or a femoral hernia in men and women. This condition requires surgery on an urgent basis to prevent severe complications.

  10. Extremities that become acutely painful, warm to the touch, and swollen on the inside (not the outside) of the leg between the ankle/calf and the thigh. Usually on one side, this may be the first sign of a blood clot.

Other problems are best seen by a provider that knows you and what you do. Routine care on a regular basis is the best advice I can give. ERs are not the place to go for routine care.

Editor’s note: John McElligott is an M.D. and Fellow of the American College of Physicians. Jeff Heinrich, who serves as the column’s medical editor, has a Doctor of Education degree and PA-C, which means Physician Assistant-Certified.