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Archive for the ‘Influenza’ Category

Influenza Dispo

ou might have noticed new green signs around MC level directing patients to the new flu clinic.

We’re trying to track who is sent there, from the ED.

If you have a patient who you think can be safely sent to this clinic, when you’re dispo’ing them in Epic, click the new Flu Clinic button (see below):

The new flu clinic is open from 9a-9p and is intended for treat & release patients. They have a limited capacity to give IV fluids or meds (If you have a patient with markedly abnormal vitals or substantial comorbidities, or you think your patient may end up getting admitted, this is NOT a good candidate for the flu clinic).

Written by phil

January 15th, 2013 at 5:36 pm

Posted in Influenza

Influenza Update

the young and old
–anyone with co-morbidities (looks like if your only issue is HTN though, you can withhold on these patients)
–pregnant (though be careful with the Pregnancy Class of the anti-viral you use), immediately post-partum women
–longterm care facility patients
–the above, ESPECIALLY if it’s within 48 hours; as well as the healthy (i.e., no co-morbidities, but maybe they look particularly miserable), within 48 hours

In more detail below:

Persons at higher risk for influenza complications recommended for antiviral treatment include:

Children aged <2 years;*

Adults aged ?65 years;

Persons with chronic pulmonary (including asthma), cardiovascular (except hypertension alone), renal, hepatic, hematological (including sickle cell disease), metabolic disorders (including diabetes mellitus), or neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy [seizure disorders], stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, or spinal cord injury);

Persons with immunosuppression, including that caused by medications or by HIV infection;
Women who are pregnant or postpartum (within 2 weeks after delivery);
Persons aged <19 years who are receiving long-term aspirin therapy;
American Indians/Alaska Natives; persons who are morbidly obese (i.e., body-mass index ?40); and
Residents of nursing homes and other chronic-care facilities.

Clinical judgment, on the basis of the patient’s disease severity and progression, age, underlying medical conditions, likelihood of influenza, and time since onset of symptoms, is important when making antiviral treatment decisions for high-risk outpatients.

When indicated, antiviral treatment should be started as soon as possible after illness onset, ideally within 48 hours of symptom onset. However, antiviral treatment might still be beneficial in patients with severe, complicated or progressive illness and in hospitalized patients when started after 48 hours of illness onset

In the meanwhile, a few simple things you should be doing at Sinai and Elmhurst:

* Get masks on patients! The point is to prevent transmission to staff and to that liver transplant patient lying 14 inches away from your patient. Even before you make the diagnosis, if the triage complaints might be flu, bring a mask with you to the bedside. (Yes, we will work with triage to see this happens there.) When you send such patients home, give them a handful of masks
* If the diagnosis is influenza or you think it might be, list the diagnosis as ‘influenza-like illness.’ Don’t just put down ‘viral syndrome’ or ‘uri’ – though you could list these as secondary diagnoses.
* I tried to prescribe Tamiflu for a friend today (HIV+ and didn’t get vaccinated) and discovered that many Duane-Reade pharmacies are OUT of Tamiflu. Consider using Relenza. The full info on whom to treat is below in the CDC recs.
* Consider ILI in your admitted patients as well.

– There will be LOTS of communications about this so keep your eye on your inbox. More info is at:

– CDC influenza activity tracking can be found at:

– NYC tracking info is at

– CDC summary including treatment options

Written by phil

January 14th, 2013 at 9:32 pm

Posted in ID,Influenza