Flu: Basic guidelines to determine whether a visit to the emergency room is necessary

A 38-YEAR-OLD man came to our emergency department recently complaining of body aches, fever, decreased appetite and nausea. He waited in the lobby for several hours before I examined him.

His symptoms were typical of the flu. After examining him I prescribed rest at home, Tylenol for fever and plenty of fluids. A follow-up phone call two days later confirmed he was much better.

Every winter, people with colds or the flu fill emergency waiting rooms, sitting or standing uncomfortably for hours, only to be told to go home, rest and drink fluids.

Cold symptoms (cough, mucous congestion, intermittent fever and body ache) usually don't require a doctor's care. Viruses, not cold air or bacteria, cause both colds and the flu, and antibiotics won't help.

Acetaminophen (Tylenol) and/or ibuprofen (Motrin) can bring down the fever. Over-the-counter cold preparations may help with symptoms of congestion and cough, and often help people get the sleep they need to recover.

It's important to drink plenty of fluids to prevent dehydration. And, wash your hands frequently to avoid giving your illness to someone else.

Diarrhea and vomiting usually don't need urgent treatment by a doctor, unless there is also severe abdominal pain. Getting and retaining fluids is key; drink clear soup, Gatorade or similar sports drinks for children and adults. Sipping fluids slowly, or eating frozen juice bars, are good ways to stay hydrated when feeling ill.

Some worrisome signs and symptoms that require medical attention include the following:

• An infant 3 months or younger with a fever of 100.4 or higher needs to see a doctor. Infants can become seriously ill quickly, so check their temperature if they are warm or are not feeding properly.
• Others with fever of 100.4 or higher that persists for three days, especially if it is associated with a stiff neck, mental confusion, low fluid intake or rash.
• Inability to take or retain fluids, often seen with severe sore throat, persistent vomiting or severe diarrhea. Infants and young children should have at least three wet diapers a day. Lack of tears when crying suggests dehydration, as do dry lips and mouth, and decreased urination. Remember, most of us can survive weeks without food, but we can die in a few days without fluid.
• Shortness of breath is always worrisome. Those with wheezing or rapid breathing should go to the ER right away.
• Chest pain can indicate a heart attack, especially in men older than 50 and women older than 60, and it doesn't have to be on the left side of the chest. Call 911 immediately.
• Facial drooping, weakness on the left or right side of the body, or difficulty speaking may all be symptoms of stroke. Call 911.

If you do go to the ER, remember to bring all your medicine containers. You may save yourself an unnecessary trip by calling your family doctor or the advice nurse first.

These basic guidelines can help you determine whether a visit to the emergency room is needed. If in doubt, though, it is safer to go to the ER.

Reilly works in the emergency room at the Contra Costa Regional Medical Center in Martinez.

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