BCRT: British Columbia Respiratory Therapy

A.  Context

Identification and investigation of hospitalized cases of influenza is needed to assess the effect of

Swine-origin influenza A/H1N1 virus (S-OIV) in BC.  The BC College of Physicians also sent an email on

July 2, 2009 to all physicians from the Provincial Health Officer that included this request to test for

influenza.  S-OIV continues to circulate in BC and in recent weeks, provinces have noted increasing

numbers of hospitalization due to S-OIV

B.  Guidelines for testing

• TEST all patients admitted overnight (or longer) to hospital with a history of recent acute

respiratory illness (i.e., history of fever and new or worse cough/breathing difficulty, with or

without other flu-like symptoms such as sore throat, rhinorrhea, sneezing, myalgia, arthralgia,

headache, fatigue, etc.);

• Test as soon as possible on admission to increase likelihood of virus detection;

• Test even if the etiology appears to be bacterial;

• Specimen collection for influenza testing may include a nasopharyngeal (NP) swab or

bronchoalveolar lavage (BAL). If patient presents with a rapidly progressive acute respiratory

illness that is negative by NP swab for influenza A/H1N1, additional testing should be performed

on tracheal or other pulmonary samples, if clinicians suspect influenza pneumonia diagnosis.

NP samples should be collected on viral swabs (ideally, COPAN flocked swabs);

• Specimens should be submitted to BCCDC Public Health Microbiology & Reference Laboratory,

with “hospitalized” written in large letters on the requisition;

• The requisition form, along with detailed instructions, can be found online at

http://www.phsa.ca/bccdcpublichealthlab (click on “Forms & Requisitions” on the left-hand panel,

then choose “H1N1 Flu Virus: Virus Culture Form”);

• Start antivirals according to clinical judgment without waiting for test results.  Antivirals

are most effective when administered within 48 hours of illness onset.

C.  Reporting of Cases

Lab-confirmed S-OIV cases who are admitted to hospital must be reported to the Public Health

Unit in the area where the patient lives. Public health staff will follow-up with detailed investigation of

hospitalized, lab-confirmed S-OIV cases.

Abbotsford HU

Tel:  604-864-3400 Agassiz HU

Tel:  604-793-7160 Burnaby HU

Tel:  604-918-7605 Chilliwack HU

Tel:  604-702-4900 Cloverdale HU, Surrey

Tel:  604-575-5100 Guildford HU, Surrey

Tel:  604-587-4750

Hope HU

Tel:  604-860-7630 Langley HU

Tel:  604-539-2900 Maple Ridge HU

Tel:  604-476-7000 Mission HU

Tel:  604-814-5500 New Westminster HU

Tel:  604-777-6740 Newport HU, Port Moody

Tel:  604-949-7200

Newton HU, Surrey

Tel:  604-592-2000 North Delta HU

Tel:  604-507

-5400 North Surrey HU

Tel:  604-587-7900 Port Coquitlam HU

Tel:  604-777-8700 South Delta HU

Tel:  604-952-3550 White Rock HU

Tel:  604-542-4000

After Hours Public Health Emergency Pager:  604-527-4806.  Ask for the Medical Health Officer On-Call

The World Health Organization is convening a meeting of its emergency committee on pandemic influenza today to seek its advice on whether to move the current outbreak of swine influenza to Phase 6, which describes a full-scale pandemic.

WahingtonPost

Clinical information on this SRI from Mexico remains the same:

• Initial symptoms:  high fever, headache, eye pain, shortness of breath, extreme fatigue
• Rapid progression to severe respiratory distress within about 5 days, many needing mechanical ventilation
• Most cases are previously healthy young adults (age 25-44), including some health care workers
• The outbreak virus is resistant to amantadine but sensitive to oseltamivir.  The current seasonal influenza
• vaccine is not expected to provide much if any protection against this new swine flu virus.

Severe Respiratory Illness (SRI) in Mexico another example of need to take care with SRI
Recent media reports on serious respiratory illness (SRI) in Mexico are a good reminder that unusual SRI’s can occur anywhere in the world.  It is important to take care to protect yourself, your patients, and other health care workers against infectious SRI.
BCCDC has advised that two clusters of about 100+ patients with SRI have been identified in various parts of
south and central Mexico.  Nine of the patients died.  The situation is still under investigation and it has not yet been determined if these cases of SRI are unusual or not.  Here is what has been reported at this point:

• The cases developed influenza-like illness (ILI) (ILI is typically defined as fever + cough + other symptoms.)
• Rapid progression to severe respiratory distress within about 5 days
• A high proportion of cases required mechanical ventilation
• The case-fatality rate was relatively high among hospitalized patients (5% in one cluster and 20% in the other)
• Most cases were among previously healthy young adults
• Some health care workers were affected

Abstract

Background: Pneumonia viruses such as influenza may potentially spread by airborne transmission. We studied the dispersion of exhaled air through a simple oxygen mask applied to a human patient simulator (HPS) during the delivery of different oxygen flow in a room free of air currents.

 

 

simple-mask-aerosol-dispersion

Original CHEST article

We have seen more and more children coming into our emerg dept. with respiratory issues, so it may be time to brush up on Respiratory Syncytial Virus.

It is probaby the most common cause of pneumonia and bronchiolitis in children under the age of 1. Symptons can include runny nose,fever, cough, and wheezing.

To get more info, head on over to this excellent lung disease info site found HERE

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Guillain-Barré Syndrome is the leading cause of nontraumatic acute paralysis in industrialized countries. About 30% of patients have RESPIRATORY failure requiring intensive care unit (ICU) admission and invasive mechanical ventilation. Progressive weakness of both the inspiratory and the expiratory muscles is the mechanism leading to respiratory failure. Aspiration pneumonia and atelectasis are common consequences of the bulbar muscle weakness and ineffective cough.

From the Department of Neurology at the Mayo Clinic, there appears to be diagnostic and clinical techniques in deciding when/if a patient requires admission to the I.C.U.

In the study ( from Vol. 58 No. 6, June 2001 Archives of Neurology) 114 patients with GBS who were admitted to the Intensive Care unit were studied.
In summery the results they found were the following:

Those requiring mechanical ventilation were found to have bilateral facial weakness, or dysautonomia, and bulbar dysfunction. Spirometry values indicated concern with VC <20 ml/kg, MIP ,30 cmH20 and a maximum expiratory pressure of <40 cmH20.