MDM - Influenza (Discharge)

[##]-year-old [male/female] presents with [fever/body aches/upper respiratory symptoms] with history and exam consistent with [seasonal] influenza.

Initial considerations in this patient included influenza, bacterial and viral etiologies of upper respiratory infection (URI), bronchitis, pneumonia, sinusitis, toxic exposure, sepsis, meningitis, encephalitis, and other pulmonary or cardiac etiologies among others.

Patient presented with symptoms suggestive of influenza during appropriate season.  Patient noted to [not] have significant risk factors for complications from influenza [specifically age less than 2 years/age greater than 65 years/pregnancy through to 2 weeks after delivery/chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological (including sickle cell disease), neurologic, neuromuscular, or metabolic disorders (including diabetes mellitus)/immunosuppression, including that caused by medications or HIV/persons younger than 19 years of age who are receiving long-term aspirin therapy/American Indians and Alaska Natives/extreme obesity (BMI ≥40 kg/m²)/patients in nursing homes or chronic care facilities].  Confirmatory testing for influenza felt [not to be indicated as the results were unlikely to change management/obtained in patient felt to be high risk and noted to be negative/positive].  No evidence of pneumonia on history or exam [and no evidence of consolidations on chest x-ray]. 

Influenza felt to be likely cause of symptoms in patient presenting [within 48 hours of onset of symptoms/over 48 hours from onset of symptoms] with antiviral treatment felt to be [indicated after discussion of potential benefits and risks with the patient/indicated in patient with risk factors for complications/indicated in patient with household contacts who are high risk for complications/indicated in a healthcare worker caring for high risk individuals].  Prior to discharge, we discussed return precautions, specifically for symptoms suggestive of bacterial co-infection or worsening illness, and recommended follow up with primary care provider within [2-3 days/1-2 weeks], and the patient demonstrated understanding and agreement with this plan.

Note: This is based on the 2018 recommendations for treatment of seasonal influenza from the Infectious Disease Society of America (IDSA).

https://rebelem.com/idsa-guideline-on-seasonal-influenza-management-2018/
https://www.idsociety.org/practice-guideline/influenza/

Discharge Instructions - Influenza

As discussed in the Emergency Department prior to discharge, you have been diagnosed with influenza or the flu.  The flu is an infection that can cause fever, cough, body aches, and other symptoms.  The most common type of flu is the "seasonal" flu, of which there are different forms of seasonal flu, for example, "type A" and "type B."  Besides seasonal flu, there is also the "swine" flu, which caused a worldwide outbreak ("pandemic") in 2009 and 2010, and the bird flu.  Bird flu (also known as "avian flu") is a severe form of the flu that is caused by a type of flu virus that first infected birds.

All forms of the flu can cause fever (temperature higher than 100ºF or 37.8ºC), extreme tiredness or fatigue, headache or body aches, cough, sore throat, and runny nose.  Flu symptoms can come on very suddenly.

All forms of the flu are caused by viruses.  Antibiotics provide no benefit in the treatment of viral infections.  Most patients get better within a week or two without complications.  An antiviral medication called Oseltamivir (Tamiflu) may have been prescribed to you based on how long you have had symptoms and your risk factors.  This medication is usually reserved for patients who are at a higher risk from influenza such as people 65 or older, very young children, pregnant women, and people with certain other medical problems.

It is important that you stay home, rest, and drink plenty of fluids.  You can take over-the-counter medications for pain such as Ibuprofen (also known as Advil or Motrin) or Naproxen (also known as Aleve).  You can also take Acetaminophen (also known as Tylenol) to relieve fever and body aches.

Return to the Emergency Department if you have trouble breathing or are short of breath, feel pain or pressure in your chest or belly, get suddenly dizzy, feel confused, have severe vomiting, or any new or concerning symptoms.