DerryNews.com, Derry, New Hampshire

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November 5, 2009

When to see a doctor

Concerns about H1N1 generate questions

It's becoming more common to see patients wearing a protective mask while waiting in the emergency room or in the doctor's office. Signs are posted in health care settings asking patients and visitors to wear a mask and tell staff if they are ill with flu-like symptoms. This practice is for both the seasonal flu and the H1N1 flu.

While both flu viruses need to run there course, there is a time when symptoms become so bad — especially in high-risk groups — that it is necessary to see a doctor.

"Signs to look for are fevers that can't be controlled with fever-reducing medications," said Dr. Hank Wagner, director of emergency services at Parkland Medical Center in Derry.

"Other signs are a severe cough, shortness of breath and dehydration. There is a gastrointestinal component to the H1N1 flu in some people with nausea, vomiting and diarrhea."

Children under 2 years of age and people with underlying conditions such as asthma, muscular dystrophy, and heart, lung and renal diseases who have flu symptoms should be seen by a doctor.

The number of people presenting with flu-like symptoms grew over this past weekend in Parkland's emergency department.

"We are seeing 20 to 30 extra patients a day since Saturday," Wagner said.

"The emergency department will be seeing more and more patients as doctor offices get overwhelmed."

Wagner said that Parkland has a plan in place to see extremely ill children when the children's specialty hospitals, like Children's Hospital in Boston or Dartmouth Medical Center, are full.

"We also have a plan with three phases as we begin to see more people with the flu," aid April Toomey, R.N., emergency department director.

"The first phases are to have people wear a mask if they have flu-like symptoms and then to keep them isolated in a separate waiting room," she added.

"Phase III would be setting up a tent outside with heat and electricity to see patients. We can have this set up in 10 to 15 minutes."

Parkland hasn't restricted patient visitors as of yet, but this is also part of the overall plan as the numbers of people with H1N1 increase. Testing on patients with suspected H1N1 flu is limited to those being admitted to the hospital or health care workers who have direct patient contact.

Parents bringing children and babies for wellness visits should check with their pediatrician's office about how they are isolating patients with flu-like symptoms in their waiting rooms.

Emergency warning signs that should signal anyone to urgently seek medical care

In children:

Fast breathing or trouble breathing

Bluish skin color

Not drinking enough fluids

Not waking up or not interacting

Being so irritable that the child does not want to be held

Flu-like symptoms improve but then return with fever and worse cough

Fever with a rash

In adults:

Difficulty breathing or shortness of breath

Pain or pressure in the chest or abdomen

Sudden dizziness

Confusion

Severe or persistent vomiting

Source: Centers for Disease Control

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