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The following symptoms mean the answer is the ER, not a mobile nurse: Extreme lethargy or unresponsiveness No urination for 8 or more hours Inability to keep any fluid down for 6 or more hours Rapid or labored breathing Sunken eyes, or a sunken fontanelle in infants Cool or mottled skin on the limbs Fainting or near-fainting Blue-tinged lips or fingernails These are ER presentations, not symptoms to monitor at home while waiting for a nurse to arrive