Influenza resident survival guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mounika Reddy Vadiyala, M.B.B.S.[2]

Overview

Influenza, commonly known as the flu, is an infectious disease caused by the RNA virus called the influenza viruses A and B.

Causes

Common Causes

• Influenza A
• Influenza B

Complete Diagnostic Approach

Characterize the symptoms: ❑ Fever ❑ Abrupt onset ❑ Ranges from 37.8 to 40.0°C, but it can get as high as 41.1°C (106°F) ❑ Associated with chills ❑ Headache ❑ Cough ❑ Non-productive ❑ Myalgia ❑ Chills ❑ Rhinorrhea ❑ Nasal congestion ❑ Sore throat ❑ Fatigue ❑ Pleuritic chest pain ❑ Malaise Less common symptoms: ❑ Vomiting ❑ Diarrhoea ❑ Abdominal pain ❑ Loss of appetite ❑ Dizziness ❑ Weakness

Obtain a detailed history: ❑ Age ❑ List of medications Identify persons who are at high risk of complications from Influenza: ❑ Children aged younger than 2 years ❑ Adults aged 65 years and older ❑ Persons with the following comorbidities: ❑ Chronic pulmonary disorders (including asthma) ❑ Cardiovascular disorders(except hypertension alone) ❑ Renal, hepatic, hematological (including sickle cell disease) or metabolic disorders (including diabetes mellitus) ❑ Neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy, stroke, intellectual disability (mental retardation), moderate to severe developmental delay, muscular dystrophy, or spinal cord injury) ❑ Persons with immunosuppression, including that caused by medications or by HIV infection ❑ Women who are pregnant or postpartum (within 2 weeks after delivery) ❑ Children and adolescents through 18 years who are receiving aspirin- or salicylate-containing medications and who might be at risk for experiencing Reye syndrome after influenza virus infection ❑ American Indians/Alaska Natives ❑ Persons who are morbidly obese (BMI ≥40 kg/m2) ❑ Residents of nursing homes and other chronic-care facilities.

Examine the patient: Appearance ❑ Fatigue Vital signs ❑ Fever ❑(100-104° F) ❑ Heart rate ❑ Tachycardia ❑ Respiratory rate ❑ Tachypnea Skin ❑ Flushing may be present ❑ Rash may be present ❑ Increased sweating Eyes ❑ Watery eyes ❑ Redness Nose ❑ Nasal congestion ❑ Runny nose Throat ❑ Erythema and inflammation may be present ❑ Pharyngitis Lungs ❑ Usually, lung examination is normal ❑ Findings of severe disease include: ❑ Dry cough ❑ Rales ❑ Focal wheezing

Management

Symptomatic Relief

OTC medicines provide relief for 'flu symptoms

Symptom(s)	OTC Medicine
Fever, Aches, Pains, Sinus pressure, Sore throat	Analgesics
Nasal congestion, Sinus pressure	Decongestants
Sinus pressure, Runny nose, Watery eyes, Cough	Antihistamines
Cough	Cough suppressant
Sore throat	Local anesthetics

Do's and Dont's

• Children and teenagers with flu symptoms (particularly fever) should avoid taking aspirin as taking aspirin in the presence of influenza infection (especially Influenzavirus B) can lead to Reye's syndrome, a rare but potentially fatal disease of the liver.