Guest JMPA Posted January 27, 2014 Share Posted January 27, 2014 being that the flu is so deadly that it requires everyone to be vaccinated against it, then all patients that are considered suspicious for the flu should have manditory swabs, chest x-rays, and pulmonary consults with immediate isolation. that should prevent ongoing epidemics. Link to comment Share on other sites More sharing options...
Guest Paula Posted January 27, 2014 Share Posted January 27, 2014 being that the flu is so deadly that it requires everyone to be vaccinated against it, then all patients that are considered suspicious for the flu should have manditory swabs, chest x-rays, and pulmonary consults with immediate isolation. that should prevent ongoing epidemics. LOL! It's only some of us that are required to be vaccinated depending on clinic/hospital policy. Tongue in cheek replies are entertaining. Haha! Link to comment Share on other sites More sharing options...
cinntsp Posted January 27, 2014 Share Posted January 27, 2014 For those that missed the tamiflu discussion in another thread: Some of the points from the EMRAP discussion: - Oseltamivir's supporting data is primarily based on a Roche-produced meta-analysis of unpublished studies(that they would not release) - Cochrane reviewers asked for the data and Roche would not provide it initially. They finally released some of the data after public pressure. - The Cochrane reviewers and another independent group reviewed it and found: 1. Symptoms - oseltamivir reduced flu-like symptoms by a little less than a day if administered within 48hrs of symptom onset BUT increased nausea and vomiting. It's basically a trade. 2. Complications - No effect. Does not reduce complications vs. placebo. Doesn't reduce hospitalizations, M&M, etc They state that two of the trials reviewed contained elderly and chronically ill patients only, which is who we often believe need this drug. This group actually doesn't even get the symptom reduction benefit! 3. Spread of disease - Contacts get sick just as often as those near influenza patients given placebo, but have reductions in "culture proven" influenza. Conclusion: Oseltamivir is not helpful or useful. Link to comment Share on other sites More sharing options...
Derbingle Posted January 27, 2014 Share Posted January 27, 2014 " I was kind of feeling reassured after seeing you in the clinic but now I've made it to the pharmacy and you've given me a prescription for Zofran (which now keeps me from taking my screaming rug rats through the drive-thru at McDonald's when I'm already feeling crappy because of the higher co-pay, or in some cases OOP cost) in lieu of a cheaper promethazine prescription. :-)" Do I really have to state specifics of anti nausea medications? You can use what you like. The pts usually know what works for them and I give it, sometimes RX for both (saying this is so time consuming..haha!) but in the Er I stop the nausea with zofran if theyre feeling sick so they can drink and also drive themselves home. ;) "On a more serious note, I have always been somewhat leery of using not specific, but too specific diagnoses in an urgent/emergent setting such as "viral syndrome" as opposed to LRI (leaves you the option of bronchitis or pneumonia of any etiology since technically the LRT begins below the cricoid cartilage). Same goes for the more financially rewarding "gastroenteritis" based upon nothing more than a Hx/PE as opposed to N/V/D." I have been told by many physicians, if you dont have a specific dx then dont make one. Viral syndrome can be the flu or a URi. What do you choose if you dont do rapid flu thats positive? You dont really know for sure. The rapid flus have false negatives, the rapid strep as well. Clinical sx and looking at the patient are key. Sick patients, look, well sick. VS key. Return precautions. And also, i do not dx gastrenteritis specifically. I put vomiting, diarrhea, dehydration. Link to comment Share on other sites More sharing options...
Derbingle Posted January 27, 2014 Share Posted January 27, 2014 Uhmmmm.....My quotes never turn out right. My bad. You guys understand. :) Link to comment Share on other sites More sharing options...
Guest Paula Posted January 27, 2014 Share Posted January 27, 2014 I have prescribed Tamiflu once this season. It was to my collaborating physician who called me on the weekend and asked if I would call it in for him. He was the last in the clinic to get his immunization and he got it after we had our first positive flu swab two weeks ago. Two days later he was sicker than a dog. Kinda funny, really. Link to comment Share on other sites More sharing options...
DogLovingPA Posted January 28, 2014 Share Posted January 28, 2014 I work in UC and our experience is similar to Paula's..... almost everyone who walks through the door is regularly given antibiotics for their viral illness by their PCP or other urgent cares and they don't understand that a URI is viral (because they always get a zpack for it). Patients insist that their kids can't possibly have the flu or that they must have pneumonia (after 1 day of cough) because they "feel so terrible". We do a TON of flu swabs here.... Honestly, a lot of the patients get mad if you don't test them for something (strep, flu, etc). Link to comment Share on other sites More sharing options...
Acebecker Posted January 28, 2014 Author Share Posted January 28, 2014 I work in UC and our experience is similar to Paula's..... almost everyone who walks through the door is regularly given antibiotics for their viral illness by their PCP or other urgent cares and they don't understand that a URI is viral (because they always get a zpack for it). Patients insist that their kids can't possibly have the flu or that they must have pneumonia (after 1 day of cough) because they "feel so terrible". We do a TON of flu swabs here.... Honestly, a lot of the patients get mad if you don't test them for something (strep, flu, etc). I think there is a role for the "therapeutic" flu or strep test... Just don't believe we should be testing everyone with a fever necessarily. Some patients have anxiety issues surrounding their health and they'll worry and cause palpitations, SOB, nausea, vomiting and whatnot if they don't know. So in my mind it's most appropriate care to do the test even if it won't change the Tx decision. Case by case, if you ask me. No blanket statements regarding this practice. Andrew Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted January 28, 2014 Share Posted January 28, 2014 I think there is a role for the "therapeutic" flu or strep test... Just don't believe we should be testing everyone with a fever necessarily. Some patients have anxiety issues surrounding their health and they'll worry and cause palpitations, SOB, nausea, vomiting and whatnot if they don't know. So in my mind it's most appropriate care to do the test even if it won't change the Tx decision. Case by case, if you ask me. No blanket statements regarding this practice. Andrew Ah, a cousin of therapeutic phlebotomy. :-) Link to comment Share on other sites More sharing options...
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