What’s Your Diagnosis? Pediatric Influenza in the Emergency Department
December 17, 2020
Posted by Andy Jagoda MD in: What's Your Diagnosis , trackback
Welcome to this month’s What’s Your Diagnosis Challenge!
But before we begin, check to see if you got last month’s case on Neonatal Resuscitation in the Emergency Department right.
Case Presentation: Pediatric Influenza in the Emergency Department: Diagnosis and Management
An 18-month-old girl with a runny nose and fever lasting 1 day is brought to the ED by her parents…
- The girl is up-to-date on her scheduled vaccinations, but has not received an influenza vaccine yet for the season. Her parents also report that she has had frequent coughing episodes, some resulting in vomiting.
- The girl’s vital signs are: rectal temperature, 39.2°C (102.6°F); heart rate, 130 beats/min; respiratory rate, 36 breaths/min; and oxygen saturation, 100% on room air. On examination, the girl is not in ap- parent distress, she does not seem to be dehydrated, and her mucous membranes are moist. She has minimal nasal congestion. The patient’s tympanic membranes are clear and not bulging. Some coarse crackles are heard, more in the right lung base, although the examination is limited due to crying. There is no respiratory distress when the patient is calm. Her abdomen is soft and neither tender nor distend- ed. Her capillary refill time is 2 seconds.
- Is influenza testing appropriate? If so, what type of test should be conducted and how reliable would the result be? Is this patient at increased risk for a more severe disease course? Given the pulmonary findings, could this patient have bacterial or viral pneumonia? Should a chest radiograph be ordered? Is evaluation of the patient’s blood and/or urine necessary?
You called the microbiology laboratory, and the technician confirmed your suspicion that a new influenza outbreak had begun in your area. You also learned that the CDC has published guidelines for the evalua- tion and treatment of patients who present with influenza-like illness. You reviewed the agency’s website, which outlines the specific groups of patients who are known to be at higher risk for a severe disease course. You ordered a chest radiograph, which showed no specific infiltrates. You also ordered an influenza rapid test. You decided to initiate supportive care and treatment with oseltamivir. The patient was dis- charged from the ED with close telephone follow-up planned with her primary care provider.