Sunday, August 7, 2011

CASE 1: A 45 yo Accountant coming in for a Flu shot





                                                              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.




15 comments:

  1. Very interesting case!

    Issues 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

    ReplyDelete
  2. Dr Tricia,

    Great 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

    ReplyDelete
  3. 1.appreciate his motivation to protect himself form the Flu and keep healthy
    2. 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

    ReplyDelete
  4. Tricia,

    Is 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

    ReplyDelete
  5. 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.

    Tricia

    ReplyDelete
  6. Is there anything "simpler" you can offer him or "his family"?

    Dr Vinh Tran
    MBBS FRACGP
    www.doyouhavedepression.blogspot.com
    www.priorityhealthmedicalcentre.com.au
    www.fracgpexamsupport.blogspot.com

    ReplyDelete
  7. I see, Flu vaccine for his families therefor reduced his risk.

    Tricia

    ReplyDelete
  8. With regards to the Epipen, what is the requirement for prescribing the Epipen?

    Dr Vinh Tran
    MBBS FRACGP

    ReplyDelete
  9. History of anaphylaxis and needs Allergy specialist review for the 1st prescription.

    Tricia

    ReplyDelete
  10. What else?

    Dr Vinh Tran
    www.fracgpexamsupport.blogspot.com
    www.doyouhavedepression.blogspot.com
    www.priorityhealthmedicalcentre.com.au

    ReplyDelete
  11. education re Epipen use, medical alert bracelet

    Tricia

    ReplyDelete
  12. Tricia,

    There 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

    ReplyDelete
  13. anaphylaxis action plan?
    Sorrey, I don't know.

    Tricia

    ReplyDelete
  14. Yes, you will need to write up and explain an anaphylaxis plan with the patient.

    Please 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

    ReplyDelete
  15. Thanks.
    I read the website on Sunday and I got a case of anaphylaxis (after ate prawn) on Monday. Can't believe!

    Tricia

    ReplyDelete