When Should You Go to the ER?

Guest blogger Matthew Hoffman, MD, has written for WebMD since 2006. He is a board-certified internist and is currently a fellow in pulmonary and critical care medicine at Emory University, where he also completed medical school and residency.

Emergency departments across the country are reporting large increases in the number of patients coming in with flu-like illness. While a few have severe H1N1 influenza, ER docs say most are people with mild illness.

It can be hard to sort out just how risky flu symptoms are, and when to seek medical attention. When do you need to go to the emergency room, or take your child to the ER?

You or your child's symptoms are the most accurate test for the severity of an influenza infection. Body aches, fevers, cough, sore throat, nausea, vomiting and diarrhea: you may feel the worst you've ever felt, but all these are normal flu symptoms. If you're not in a high-risk group, you don't necessarily even need to call your doctor. Staying at home, drinking fluids, and acetaminophen are adequate treatment for most people with H1N1 or seasonal flu.

Severe or complicated influenza that requires an ER visit comes with serious symptoms. These include (in adults):

• Difficulty breathing or shortness of breath


• Pain or pressure in the chest or abdomen


• Sudden dizziness


• Confusion


• Severe or persistent vomiting

In children, emergency warning signs of flu include:

• Fast breathing or trouble breathing


• Bluish skin color


• Not drinking enough fluids


• Not waking up or not interacting


• Being so irritable the child doesn't want to be held


• Flu-like symptoms get better, but then return with a fever and a worse cough


• Fever with a rash

These can be signs of pneumonia, low oxygen levels, or severe dehydration. People with these severe flu symptoms should be evaluated right away, which usually means the emergency department.

What about people with the regular symptoms of influenza, but who are at high risk for flu complications? These include children under 5 years old (and especially under 2), people over 65, pregnant women, and most people with chronic medical conditions.

If you're in one of these high-risk groups, you should get vaccinated against H1N1 and seasonal flu. If you develop flu symptoms, but none of the emergency warning signs, call your doctor's office for advice before heading straight to the emergency room.

Going to the ER with mild illness exposes other people to H1N1, if you do have it. If you don't, you're exposing yourself to catching H1N1 from someone in the ER.

Some people go to the ER seeking a definite diagnosis of H1N1 flu. But the CDC recommends not testing most people for H1N1 flu. Flu - seasonal or H1N1 - is diagnosed by its symptoms, and a definite diagnosis usually isn't important. You don't need a positive test to get treated for flu.

If you don't have any of the emergency warning signs, save yourself the trip to the ER.