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Topics > Healthy Outlook > The Flu: When Should I Go To The Emergency Room?

The Flu: When Should I Go To The Emergency Room?

Published by Contra Costa Times

Posted on Wed., October 14, 2009
By Brenda Reilly, MD

KNOWING WHEN TO go to the ER, when to make a short-notice appointment with your doctor, and when to stay home can save you a great deal of time and money. And it can save your life.

On a recent day, Mrs. J, an elderly diabetic, came to the Martinez hospital ER, complaining of a high fever, vomiting, diarrhea and a constant cough. She had been taking Tylenol, but the fever persisted and her body ached.

Later, TR, a 9-year-old boy, was brought in by his mother who was concerned about his three days of cough, fever and vomiting. He was taking fluids fine, and seemed better, but she wanted to be sure he didn't have the swine flu and needed medicine.

Still later in the day, Mr. T, a 38-year-old generally healthy man with fever and cough came to the ER because he was concerned that his fever kept returning for the past week after the Tylenol wore off, and his diarrhea was ongoing. He too, thought he might have the swine flu and need medicine.

Each of these patients had the flu, though we'll probably never know if it was the H1N1 (swine) flu, or the seasonal flu. But which do you think needed to come to the emergency room?

The need to go to the ER should be based on how sick you are, not on which type of flu you might have.

People with chronic illnesses such as diabetes, asthma, COPD or congestive heart failure should be seen within a day by their regular doctor or, if unable to arrange an appointment, come to the ER.

The H1N1 flu is also particularly dangerous for infants and pregnant women, so they too, should come to the ER more readily than nonpregnant women.

Symptoms that may lead to being treated with an antiviral medication like Tamiflu, or the need to be hospitalized include:

  • High fever (102 degrees or higher)
  • Severe fatigue
  • Persistent cough with yellow or green phlegm
  • Shortness of breath
  • Confusion
  • Dehydration (thirst and light-headedness) from vomiting and/or diarrhea.

Children are generally better off staying home even if they are not eating during their illness.

Generally, healthy people, including children, can go safely without food for a week or two, though we all need liquids within a day or two.

Worrisome signs in children include:

  • No interest in playing or interacting
  • Decreased fluid intake and urination
  • Shortness of breath.

Most nonpregnant, healthy people with the flu should stay home and stay hydrated. That means drinking plenty of water, Gatorade (or other sports drink) or soup.

Popsicles are a good choice—kids like them, and they take a while to finish so they are less likely to cause vomiting. Avoid milk products, which can worsen diarrhea.

Tylenol or Motrin reduce the fever, body ache and headache of the flu, but these medicines don't "cure" the flu. They just relieve the symptoms for four to six hours. You'll need to keep taking them as long as the symptoms persist, which can be a week or two.

So, of the three patients that came to the ER, Mrs. J needed to come. But TR and Mr. T didn't.

Reilly is an emergency physician at the Contra Costa Regional Medical Center in Martinez.

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