When to go to the ER or call 911 in Puerto Rico

Chest pain: when to go to the ER? Right now, if it is pain, pressure or tightness that does not go away. The NHLBI says to call 911 even if you are not sure it is a heart attack, and not to drive yourself or let someone else drive you: an ambulance is the safest way to get there. Heart attack pain does not go away with rest or medicine, and it can start mild and come and go over hours.

Call 911 right away if you have:

The signs come on suddenly: numbness or weakness in the face, arm or leg, especially on one side; confusion or trouble speaking or understanding; trouble seeing; trouble walking, dizziness or loss of balance; or a severe headache with no known cause.

A quick check: ask the person to smile (does one side of the face droop?), to raise both arms (does one drift down?) and to repeat a simple phrase (is the speech slurred or strange?). If you see any of these signs, call 911 right away and note the time they started.

Shortness of breath, what to do: call 911 or go to the ER if trouble breathing comes on suddenly or is so bad you can barely talk, if someone stops breathing, or if someone is choking.

Also call 911 if the lips, tongue or throat swell after a sting, a food or a medication. And go to the ER if shortness of breath comes with chest pain or pressure, with blue lips or skin, or if you are short of breath at rest or with very little effort.

If you have asthma, use your rescue inhaler as your action plan says while you get help: see asthma. If the shortness of breath is mild, has lasted days and you have none of these signs, the doctor can evaluate you by video.

If someone faints, check that they are breathing and, if needed, call 911. Lay them down, loosen tight clothing around the neck and raise their feet about 12 inches (30 cm) above the heart; if they vomited, turn them on their side. Call 911 if they:

Dengue is common in Puerto Rico. Warning signs of severe dengue usually begin 24 to 48 hours after the fever goes away. Go to an emergency room right away if there is:

• Belly pain or tenderness
• Vomiting (at least 3 times in 24 hours)
• Bleeding from the nose or gums
• Blood in vomit or stool
• Extreme tiredness or restlessness

Fever with a stiff neck, or with spots on the skin that don't fade when you press a glass against them, is also an emergency. More in the guide to dengue warning signs.

We see children of all ages by video, but some signs cannot wait. For their safety, a baby under 3 months with a temperature of 38.0 °C (100.4 °F) or higher needs emergency care now. At any age, go to the ER or call 911 if your child:

If you or someone close to you is thinking about self-harm or suicide, call Línea PAS now at 1-800-981-0023, or call or text 988. Both are free and confidential. If there is immediate danger, call 911. In a crisis, don't wait for a video visit: call these lines.

If someone swallowed, breathed in or touched something that may be poisonous, or took too much of a medication, call Poison Help at 1-800-222-1222, which serves Puerto Rico. If the person is not breathing, is having a seizure or will not wake up, call 911.

If you have any of the signs on this page, don't book a visit: go to the ER. If you're unsure, go. Dr. Diana Nieves Castro has several years of emergency-department experience, which is why we say it plainly.

If you have no warning signs but your problem can't wait, that is what virtual urgent care is for: the doctor evaluates, diagnoses and treats problems like a urinary tract infection, a cold or a sinus infection, and if needed gives you a lab order for a lab near you. See also where to go when you're sick.