MANAGEMENT CASE 8 mins
John is a 45yo Accountant who presents to you for a Flu Vaccine. He has well controlled moderately severe asthma with the following medications. He has been admitted to hospital in his childhood but has been well controlled for many years on medications
Medications:
Seretide 500/50 1 puff bd
Ventolin 2 puffs every 4hours prn
He is not on any other medications
Over the last few weeks, he has not been needing to use his ventolin at all. He is allergic to eggs and gets anaphylaxis from it. He has been admitted to hospital about 10yrs ago and did require some adrenalin at the time. He has been good since.
Things to think about with the Question above...
How do you use for 3mins Pre-case reading here?
Share with us your thoughts... (do it under anonymous or first name basis)
What is your problem list or issues we need to address here?
What do we have to clarify further?
How would you manage this?
If you want a good resource on Anaphylaxis with access to Anaphylaxis plan templates, go to ASCIA Australasian Society of Clinical Immunology and Allergy.
Very interesting case!
ReplyDeleteIssues need to be addressed -
1.suitability/contraindication to Flu vaccine, previous Flu vaccination? reaction?
2. anaphylaxis prevention and management - Epipen and injection skills, family and co-worker education
3. other allergy which may contribute to asthma, management,
4. asthma management plan,
5. other family members (such as children) has anaphylaxis reaction? management?
6. smoking, health promotion?
What do we have to clarify further-
the nature of previous anaphylaxis (hospital records?)
previous Flu vaccination and reaction
How will we manage this -
I will not give flu vaccine
request hospital record re previous anaphylaxis episode today
refer to Allergist for r/v ASAP (speak to the Allergist re the pt needs Epipen)
Educate pt and family
long term management
asthma
life style/health promotion
Dr Tricia
Dr Tricia,
ReplyDeleteGreat response on the "Issues that needs to addressed"
If this person really want to protect himself from the Flu and insist on having the Fluvax, what will be your response?
Dr Vinh Tran MBBS FRACGP
www.priorityhealthmedicalcentre.com.au
www.doyouhavedepression.blogspot.com
www.fracgpexamsupport.blogspot.com
1.appreciate his motivation to protect himself form the Flu and keep healthy
ReplyDelete2. explain that anaphylactic reaction to egg is one of the absolute contraindications to Flu vaccine, the risk is too high
3. explain there are other measures to help him, such as smoking cessation (if he smokes), optimize asthma control, regular exercise and healthy diet to keep healthy, avoid contact people with flu, avoid crowded places in flu season.
Dr Tricia
Tricia,
ReplyDeleteIs there anything you can offer him with regards to protection against the flu?
Dr Vinh Tran MBBS FRACGP
www.doyouhavedepression.blogspot.com
www.fracgpexamsupport.blogspot.com
www.priorityhealthmedicalcentre.com.au
antiviral agents such as Relenza, Tamiflu and Amantadine are sued for treatment of Flu (starting with 48 hours of Flu symptoms). They are not recommended for routine prophylaxis against Flu. However, they may be used to prevent flu in poorly vaccinated communities at risk. I think this patient will be benefit from antiviral agent if he is at high risk of developing symptomatic Flu.
ReplyDeleteTricia
Is there anything "simpler" you can offer him or "his family"?
ReplyDeleteDr Vinh Tran
MBBS FRACGP
www.doyouhavedepression.blogspot.com
www.priorityhealthmedicalcentre.com.au
www.fracgpexamsupport.blogspot.com
I see, Flu vaccine for his families therefor reduced his risk.
ReplyDeleteTricia
With regards to the Epipen, what is the requirement for prescribing the Epipen?
ReplyDeleteDr Vinh Tran
MBBS FRACGP
History of anaphylaxis and needs Allergy specialist review for the 1st prescription.
ReplyDeleteTricia
What else?
ReplyDeleteDr Vinh Tran
www.fracgpexamsupport.blogspot.com
www.doyouhavedepression.blogspot.com
www.priorityhealthmedicalcentre.com.au
education re Epipen use, medical alert bracelet
ReplyDeleteTricia
Tricia,
ReplyDeleteThere is one more important thing that is necessary with the prescribing of epipen. It is part of authority requirement I think?
Clue....something to do with a "plan"....
Dr Vinh Tran
anaphylaxis action plan?
ReplyDeleteSorrey, I don't know.
Tricia
Yes, you will need to write up and explain an anaphylaxis plan with the patient.
ReplyDeletePlease click on the link at the end of the case www.epipenclub.com.au
It will give you a template to follow.
Dr Vinh Tran
MBBS FRACGP
www.doyouhavedepression.blogspot.com
www.fracgpexamsupport.blogspot.com
www.priorityhealthmedicalcentre.com.au
Thanks.
ReplyDeleteI read the website on Sunday and I got a case of anaphylaxis (after ate prawn) on Monday. Can't believe!
Tricia