"Flu-Like Symptoms"

[CJMO]

"In-Flu-Enza... Then immediately turned around and flew over the cuckoo's nest."

With flu being on the last quarter stretch this season I thought it would be fun to share some stories of how you went down the rabbit hole chasing patients triaged as "Flu-like symptoms"; ultimately leading to a complete 360 diagnosis.

For example:

Triage note: 23AAF here with "Flu-like symptoms" (Fever, cough, body aches).  + sick contact at home with similar sx.

23AAF previously healthy, sexually active female, presents with fever (Tmax 104), dry cough, HA, N/V x 1 episode, and body aches that start in right lower back area then radiates to her entire body. Onset 1 day ago. Reports that her son is having similar sx that started a day before hers. Endorses +malaise, +Rhinorrhea, +congestion, +lower abdominal pain, +anorexia, +yellow malodorous vaginal discharge,  Denies Vision changes, sore throat, neck pain/stiffness, chest pain, SOB, diarrhea, dysuria, hematuria, pregnancy.

On Exam she is afebrile, VSS wnl. HEENT exam unremarkable. Neck supple, FROM without meningismus. Lungs CTAB. Heart RRR no mgr. Abd +bs, non distended,  moderate suprapubic, LLQ, and RLQ ttp most appreciated, no CVAT b/l. 

*Sigh... really I have to do a pelvic on a "Flu-like sx"?!*

Pelvic exam no discharge seen, +CMT, b/l adnexal ttp without masses, uterine ttp.

Ddx:  

1. Viral syndrome - high prob based off hx, however no objective findings, flu swab negative.

2. GYN path - Mod prob for PID, sexually active, hx of vag d/c, pelvic exam with CMT, b/l adnexal ttp, uterine ttp, WBC wnl, mild pyuria on UA, G/C cultures obtained. Will treat clinically. TOA unlikely, afebrile, NAD, no adnexal masses, sx x 1 day. TAUS neg for masses. UPT neg.

3. Appy - Low probability, Alvarado score 4. RLQ US neg for 2nd signs of appy.

4.UTI - no dysuria, mild pyuria/hematuria, no cvat.

Dx: Viral syndrome and PID

 

Anyone else have good ones?

 

**G/C culture grew + 3 days later too.

[Eastcoast PA-C]

Just got home from a shift with a “flu-like symptoms” patient. Vitals stable, HR right about 100 with some quiet lung sounds on the right. Afebrile, nontoxic. Something felt off about it so I caved and did labs and a chest X-ray to shut up the voice in my head.

 

WBC was 42k, CXR showed right sided hemopneumothorax, which CT characterized as empyema with a 50% pneumo. Surgeon opted to take her to the OR to drain everything.

 

Flu swab was negative though, so at least she has that going for her.

 

 

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[skyblu]

I just sent an email to our nurses and MAs that their triage note cannot simply say “flu like sxs.” Yesterday I had a patient whose “flu like sxs” were abdominal pain, fever, diarrhea, and vomiting. It was appendicitis.

“But that’s what the patient said!” the nurses cry. I don’t care. Ask them, “What kind of symptoms are you having, specifically?”

Flu is a diagnosis, not a chief complaint!

Sorry for the rant. This is a big pet peeve of mine.


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