(精选)【H1N1精品课件课件】 Severe Manifestations of H1N1教学课件.pptVIP

Severe Manifestations of H1N1 Michelle Harkins, MD UNMH Epidemiology H1N1 in multiple countries (177) 20-25% have required ICU level care Australia reported 40% of their ICU beds were full with H1N1 patients. Spanish cohort of 32 ICU level patients in 5 weeks with case fatality rate 25%. Common complaints Fever Cough Myalgias Headache Sore throat Sudden onset of symptoms Malaise Pulmonary Problems Primary viral pneumonitis Virus attacks lower respiratory tract more than seasonal flu Hemorrhagic secretions Multilobar infiltrates seen on CXR Severe hypoxemia Secondary bacterial pneumonia Exacerbation of underlying pulmonary disease may worsen the course of disease Potential Severe Manifestations Respiratory failure Requiring alternative modes of mechanical ventilation: APRV, High frequency oscilllator Not severe compliance problems Develop severe ARDS Pancytopenia Multi-organ failure Encephalitis and other neurologic complications Myocarditis/pericarditis Treatment Droplet precautions CDC recommendations with face mask vs N95 Sending several swabs and BAL for diagnostics Oseltamivir for minimum of 7 days Tricor can now perform PCR for H1N1 on hospitalized patients with 24 hour turnaround