In Case You Missed Last Week: January 13, 2021

Ayal Pierce:  Flu 

1) Don't forget to test for flu, especially for patients being admitted with respiratory symptoms, and if it will change management.

2) Tamiflu will likely reduce symptom duration, and will likely reduce mortality and complications in ICU patients even several days into the disease 

3) Consider Baloxivir for patients where a one time dose is more reasonable

4) Do not regularly use steroids for Flu

5) Use clarithromycin over azithromycin for H1N1 and H3N2


Joel Lange:  MIS-C 

 1)   Children are getting sick with COVID-19 but it is often a post-infectious complication 3-4 weeks later.  Mimics Kawasaki 

2)   Multisystem inflammatory syndrome is defined as:  

a.     < 21 years

b.     Fever < 38C

c.      Signs of systemic inflammation (labs)

d.     Multisystem organ dysfunction

e.     Suspected or confirmed covid diagnosis

3)   Look for cardiac abnormalities and decreased LV function – this is the big complication; bedside US & cardiac labs are an essential first step

4)   Should admit all kids for monitoring and treatment considerations (e.g., steroids, IVIG, ASA, Abx, etc) 


Joseph Skrabal:  CPC Appendicitis

1.  Consider the diagnosis of acute appendicitis in patients with lower abdominal pain, fever, nausea, vomiting, and anorexia

2.  In the correct patient, a limited abdominal ultrasound may be used as a first-line diagnostic modality as an alternative to a CT scan

3.  Conservative, non-operative management of acute appendicitis is feasible in patients without high-risk features

4.  Conservative management of acute appendicitis results in a higher recurrence rate, but fewer treatment complications