If the flu's got you down, then you have to take care of yourself.
At what point, however, should you visit the emergency room (ER)?
Flu, for most people with relatively normal immune systems, can be handled pretty well, says Dr. John Yaylagul, a University of Connecticut emergency room physician and co-owner of Velocity Urgent Care in Rocky Hill, CT.
The elderly, those with extreme diabetes or the really young have to be the most careful, he says.
One of the first recommendations of the American College of Emergency Physicians (ACEP) that necessitates an emergency department visit is if you are experiencing difficulty breathing and/or shortness of breath. There is a lot of room for interpretation here, says Dr. Yaylagul. While those above need to be more wary, anyone should take note if they continuously feel like they are fighting to catch their breath. Those that are gasping for breath, he says, are likely “weakened by the flu to the point that they have been afflicted with pneumonia.” By then, he says, it is likely that bacteria has taken over. Pneumonia, he adds, is the “most important complication of the flu.”
Sometimes, he says, people will come into the office with 30 breaths a minute as opposed to the average of 12 to 20 breaths per minute. These cases, he continues, are severe enough to bring right to the ER, because their oxygen levels are probably low (under 90 percent). When you need assistance breathing, then you can’t be seen on an outpatient basis, says Dr. Yaylagul.
One way to avoid the ER altogether is to go to the doctor within the first 48 hours of flu onset, he says. While there are many viruses that can produce headache, cough, stomach upset, and even fever, the hallmark of the flu is the fever with the abrupt onset of symptoms, he adds. This is important, says Dr. Yaylagul, because doctors now can actually test to see if you have the flu. Once determined in the office, then Tamiflu can be administered to diminish many of the symptoms. After 48 hours, he adds, the drug is not as effective.
Another recommendation from the ACEP with a little gray area is to go to the ER if you have severe or persistent vomiting or diarrhea. Does that mean two days or two hours? More likely, says Dr. Yaylagul, the time to worry is if you are in the bathroom for hours upon hours over two to three days and not able to hydrate. While his office does have IV hydration, sometimes individuals will still have to be transported to the ER for further IV hydration and stabilization. It really depends, he says, on an individual's age and current health condition. There are many times, he says, they have transported individuals to the ER from their site. Not for the flu specifically, but heart attacks and other incidents. Both Dr. Yaylagul and his Velocity Urgent Care partner, Dr. Aleksandr Gorenbeyn share over two decades of ER experience. That, says Dr. Yaylagul, is their strength – the ability to recognize a true medical emergency.
Some other ACEP recommendations that warrant an ER visit that may have to do with the flu include: having fainting spells or experiencing sudden dizziness or weakness, experiencing vision changes, experiencing confused mental status, coughing up or vomiting blood.
The flu is rampant this year. Dr. Yaylagul says they see about 40 patients a day, and at least two or three of those a day over the past six to eight weeks have had the flu. Of these, however, 95 percent have had no complications, he adds.
Those that are interested, says Dr. Yaylagul, should still get the vaccine. His office is one of the few in the state that still has the vaccine. This year, he continues, the World Health Organization (WHO), hit it at about 70 percent effective, and with the vaccine the virus is far less severe and does not last as long.
Finally, he says, “you have to be careful where you’re going.” Just as his practice is specifically designed for urgent care, some practitioners are opening urgent care clinics that have mainly general practice experience, he adds. Dr. Yaylagul says that leaves a 20 to 30 percent gray area for some cases. He also says that it means in some cases they won’t be able to handle emergencies at the facility.
Other urgent care facilities in the Hartford area were called for this article, but none returned the call. CVS has a minute clinic with a nurse practitioner, but pharmacists said that practitioners could not take the call.
In order to talk to doctors or nurses on emergency staff at Hartford Hospital or Central Connecticut Medical Center, then you would need to go through your primary doctor. Off hours these calls go through the answering service which generates from the primary care doctor.