Did you get your flu shot? We hope so. Influenza season is upon us again and it is always helpful to review the latest 2018 Infectious Disease Society of America (IDSA) update on the diagnosis and treatment of influenza.1 Notable is that influenza-confirmed patients who present within 2 days of symptoms who are deemed low risk do not automatically warrant antiviral treatment. The subsequent question then is who is high risk? The following infographic by our Guidelines Editor, Dr. Kelly Wong, summarizes the key take-home points for emergency medicine clinicians.(more…)
The child with a fever and rash in your Emergency Department (ED) may actually have measles. This year, there have been 1,182 cases of measles in the U.S., and counting. This is the highest rate in the past 27 years . Globally, measles kills over a hundred thousand children . In the U.S., one child dies for about every 1,000 cases . Emergency providers must be able to quickly detect short-term complications that can lead to death and distinguish measles from mimics like Kawasaki Disease. It’s no coincidence that this year’s outbreak is in the setting of lower vaccination rates. The CDC now has new vaccine recommendations, and it’s imperative that ED providers join forces with public health providers to prevent future measles cases and deaths (photo credit).(more…)
A 31 year old African-American male, with a history of HIV, non-compliant with medications, presents with 3 months of painful “balls and bumps” on his left thigh. He was evaluated at another hospital prior to this visit and was discharged with 7 days of TMP-SMX. He denies any fever, chills, weight loss, night sweats, or anorexia.
Chief complaint: Left-sided facial swelling
History of Present Illness: A 2-year-old male presents to the emergency department in January after waking up with left-sided facial swelling. Mother states her son has had cough and congestion for the past 4 days for which she has been giving Tylenol and a children’s cough medication. The patient went to bed, awoke the following morning with facial swelling, and was brought to the emergency department.
He has no allergies, history of trauma to the area, or bug bites. The patient is fully vaccinated including the influenza vaccine.
Sore throat accounts for a whopping 7.3 million outpatient pediatric visits. Group A Streptococcus (GAS) accounts for 20-30% of pharyngitis cases with the rest being primarily viral in etiology. However, clinically differentiating viral versus bacterial causes of pharyngitis is difficult and we, as providers, often don’t get it right. In addition, antimicrobial resistance is increasing.. So who do we test and when do we treat for strep throat? The 2012 Infectious Diseases Society of America (IDSA) guideline on GAS pharyngitis helps answer these questions.(more…)
How many times have you told a patient “The gel will be cold?” How many times have you watched a patient retract from the transducer because of the cold gel? How about a pediatric patient? Could warm gel improve your rate of clinically successful scans? It seems easy enough to install gel warmers alongside our ultrasound machines. But, should we do this?Read more
Symptomatic influenza A and B infections cause worldwide morbidity and mortality every year. Annual vaccination remains the greatest prophylactic measure, but the vaccine is not 100% effective due to mismatch between the circulating and vaccine virus strains. Although most individuals will recover from influenza without incident, some specific patient populations are at high risk for severe complications. The Infectious Disease Society of America (IDSA) recently updated their clinical practice guidelines.1 We review these key updates, including recommendations on who to test, treat, and provide chemoprophylaxis.