Guide for considering influenza testing when influenza viruses are circulating in the community (regardless of influenza vaccination history). 1Confirmation of influenza virus infection by diagnostic testing is not required for decisions to prescribe antiviral medication. Decision making should be based upon signs and symptoms consistent with influenza illness and epidemiologic factors. Initiation of empiric antiviral treatment should not be delayed while influenza testing results are pending. Antiviral treatment is clinically most beneficial when started as close to illness onset as possible. 2Signs and symptoms of uncomplicated influenza. 3Clinical manifestations and complications associated with influenza and persons who are at high risk of complications from influenza. 4All hospitalized patients with suspected influenza should be tested, as detection of influenza virus infection and prompt initiation of antiviral therapy are most clinically beneficial, and implementation of infection prevention and control measures is essential for prevention of nosocomial influenza outbreaks. 5Influenza testing may be used to inform decisions on use of antibiotics or continuation of antiviral medication, on need for further diagnostic tests, on consideration for home care, or on recommendations for ill persons living with others who are at high risk for influenza complications. 6Influenza testing may be required to inform decisions on infection control practices. 7Antiviral treatment is recommended for outpatients with suspected influenza who are at high risk for complications from influenza, or those with progressive disease not requiring hospital admission. Antiviral treatment of outpatients who are not at high risk for influenza complications can be considered based upon clinical judgment if presenting within 2 days of illness onset. Abbreviations: HF, heart failure; COPD, chronic obstructive pulmonary disease.
The optimal sequence of PALS interventions, including administration of antiarrhythmic drugs during resuscitation, and the preferred manner and timing of drug administration in relation to shock delivery are still not known. One study reported a statistically significant improvement in return of spontaneous circulation when lidocaine administration was compared with amiodarone for pediatric ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest. However, no difference in survival to hospital discharge was observed among patients who received amiodarone, lidocaine, or no antiarrhythmic medication.
It is a longstanding cultural norm to provide supplemental oxygen to sick patients regardless of their blood oxygen saturation
A recent systematic review and meta-analysis has shown that too much supplemental oxygen increases mortality for medical patients in the hospital
For patients receiving oxygen therapy, aim for peripheral capillary oxygen saturation (SpO2) of ≤ 96% (strong recommendation)
For patients with acute myocardial infarction or stroke, do not initiate oxygen therapy in patients with SpO2 ≥ 90% (for ≥ 93% strong recommendation, for 90-92% weak recommendation)
A target SpO2 range of 90-94% seems reasonable for most patients and 88-92% for patients at risk of hypercapnic respiratory failure; use the minimum amount of oxygen necessary
Mental health evaluations provided during the ED visit should include comprehensive suicide risk assessment. The SAFE-T Guide, developed by the Substance Abuse and Mental Health Services Administration (SAMHSA), may be used in conjunction with the Decision Support Tool to meet this objective.
All bite wounds and scratches should be attended to as soon as possible after the exposure; thorough
washing and flushing of the wound for approximately 15 minutes, with soap or detergent and copious
amounts of water, is required. Where available, an iodine-containing, or similarly viricidal, topical
preparation should be applied to the wound.
RIG should be administered for severe category III exposures. Wounds that require suturing should be
sutured loosely and only after RIG infiltration into the wound.
A series of rabies vaccine injections should be administered promptly after an exposure.
Emergency medicine is a field of practice based on the knowledge and skills required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of episodic undifferentiated physical and behavioural disorders (IFEM) -
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