Physician’s Assistant Discusses Treatment For Patients With Flu Symptoms

This case involves a child who presented on to the emergency room with low blood pressure and a high-grade fever. Flu was suspected and a rapid influenza test was administered. The test came back negative, and the patient was sent home. Several days later, the patient returned to the emergency room with significantly lower blood pressure. A second rapid influenza test came back positive for flu. The patient was treated for the flu but developed pneumonia shortly after and passed away. An expert physician’s assistant was sought to discuss whether or not there was a failure to timely and appropriately treat the influenza symptoms that led to the patient’s death.

Question(s) For Expert Witness

1. How routinely see patients with a similar presentation?

2. What are the best practices for when a patient like this presents to the ER?

3. Should the patient have been admitted to the ER on the first visit and treated for influenza and heart failure?

Expert Witness Response E-006207

I have 17 years of experience as a physician's assistant, with most of those including urgent care and emergency medicine work. I also have hospital medicine experience taking care of a variety of cardiac conditions. I have also been a full-time physician's assistant educator for the last 9 years. I teach medicine topics, including cardiology. I see patients with flu symptoms all the time during the flu season. I am concerned about the patient's low blood pressure, regardless of what the cause is. I wouldn't discharge a person with that low of a blood pressure, unless I had a good reason why it was low and I improved the blood pressure with IV fluids, etc. If the low blood pressure wasn't explained well (as in poor oral fluid intake, vomiting, nausea, etc.), this patient should be admitted for further workup. The patient would need labs, including a CBC to make sure anemia wasn't the cause of the low BP. I would also do an ECG to make sure that the low BP wasn't caused by something cardiac. Troponin would also be indicated. I would also like to know this person's cardiac risk factors and co-morbidities. As I said, I would admit a patient with that low of a blood pressure if it wasn't explained well and improved. That would require a significant workup in the ER and probably hospital admission. If the patient had heart failure, they needed to be admitted.