A Cook County Hospital Emergency Medicine Blog for up-to-date medicine and more.
Influenza A is frequently a big culprit of respiratory illness during the winter months. Inevitably, the question often arrives from consultants, attendings, or colleagues at sign-out, “Did they get Tamiflu?” This is often met with a variety of responses and debates regarding its efficacy at times. However, what does the literature actually say regarding the use of Tamiflu?
Kathryn McGregor, MD and Eric Leser, MD
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Source: https://en.wikipedia.org/wiki/Acute_respiratory_distress_syndrome#/media/File:ARDSSevere.png
A 78-year-old female presents with dyspnea, and her chest x-ray demonstrates signs concerning for community-acquired pneumonia (CAP). Despite your best interventions, her oxygenation and work of breathing are worsening, so you call Respiratory Therapy to initiate high-flow nasal cannula. Meanwhile, you’re left thinking, “Would steroids help turn her around? But what are the guidelines - are steroids best used for CAP or sepsis or both? What kind of CAP? When and how much?”
Taylor Wahrenbrock, MD; Kathryn McGregor, MD; and Eric Leser, MD
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Figure 1. Clustered rash with vesicles and scabbed over lesions along C6-7 dermatome.
The Case:
An otherwise healthy 3-year-old presented to the emergency department with a chief complaint of a pruritic rash for 2 days that started on the back and progressed down the arm to the hand. The child and his family were migrants recently arriving in the United States from South America and currently staying at a migrant shelter. The patient’s blood pressure was 104/60 mmHg, heart rate 100 BPM, respiratory rate 22 BPM, oxygen saturation 97% on room air, and temperature 37ºC (98.6ºF). On examination, the child was overall well-appearing, and significant only for a crusted-over patch of lesions was noted at the C6-7 dermatome on the child’s back lateral to midline, clustered papulovesicular lesions along the outer side of the left arm and involving the left hand along the C6-7 dermatome. What is causing the patient’s rash?
Michael Hohl, MD and Alisa McQueen, MD
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