Monday, April 29, 2019

Influenza in the ED

emDocs - April 29, 2019 - Authors: Mendoza C and Fairbrother H
Edited by: Koyfman A and Long B
  • Influenza can present with wide variety of symptoms and can lead to multiple complications.
  • Be aware of your local seasonal prevalence of influenza and specific strains, as it will help limit inappropriate testing and lead to timely therapy (
  • Risk stratify patients depending on their comorbidities and previous medical problems
  • A negative rapid antigen test does not rule out influenza, particularly when prevalence is high
  • A purely clinical diagnosis of influenza (i.e. no confirmatory testing) during high influenza season is reasonable for low-risk patients who are likely to be discharged.
  • For low risk patients with mild to moderate illness, treat as outpatients with oral antiviral if presenting within 48 hours of illness onset, otherwise supportive treatment is recommended.
  • Hospital admission should be based on patient’s risk factors, age, respiratory status, clinical presentation, comorbidities, and access to outpatient follow up.
  • Treatment with antiviral medications is recommended for all patients who are severely ill, have complicated illness, are at high risk for complications, or are hospitalized.
  • Be aware that pneumonia (bacterial, CA-MRSA, viral), pediatric myositis/rhabdomyolysis, and MI in elderly patients are possible contributors to why your influenza patient may be so sick."