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| No. 20 | 
Jan 06, 2007, 10:58 PM
 Re: 6 Alabama kids were on life support with flu
We here in Edmonton, Alberta have a kid on ECMO for influenza A. At first we were looking for hantavirus because she was SO sick. She seems to have turned the corner, but I find it very interesting that we were unable to obtain Tamiflu for her... there's supposed to be a stockpile of it in the province in case of pandemic...
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Jan 06, 2007, 11:18 PM
Re: 6 Alabama kids were on life support with flu Originally Posted by janfrn  We here in Edmonton, Alberta have a kid on ECMO for influenza A. At first we were looking for hantavirus because she was SO sick. She seems to have turned the corner, but I find it very interesting that we were unable to obtain Tamiflu for her... there's supposed to be a stockpile of it in the province in case of pandemic...
janfrn,
I think that some will be surprised at how little Tamiflu may be available.
Certainly not enough for a pandemic with a CFR of over 50%. There will be no prophylaxis doses for HCW. It is not possible.
Your kid should have been able to get Tamiflu or Relenza if your province was being truthful about their pandemic preparations. I am finding that in some cases, plans are just plans. They are mandated to do planning but there is no realistic follow through, and appropriate expenditure of what it is going to take.
BTW, a company down in Birmingham, Alabama was just awarded a contract to develop a parenteral antiviral drug for patients like this.
Can you imagine how we will give this kind of critical support to many cases at once? I would have some serious questions to ask of your pandemic planners about the inability to obtain Tamiflu for this patient.
| | No. 22 |
Jan 06, 2007, 11:41 PM
Re: 6 Alabama kids were on life support with flu
It boggles the mind, doesn't it? Our staffing levels are so tight that one ECMO patient strains us to the limit at times, so I can't imagine. As for the Tamiflu, well we have this fabulous Internet based reporting system for incidents like this, and once it's been activated, the cat's out of the bag, so to speak. The instant that the report is completed, it's sent to our manager, our medical director, the health region's administration, the health region's risk managment office and a couple of other high level responsible parties. I have a feeling this one will be looked at very closely.
| | No. 23 |
Jan 07, 2007, 12:24 AM
Re: 6 Alabama kids were on life support with flu
janfrn,
I wonder if I could pick your brains, so to speak since PICU is not my area of expertise. I am trying to understand how these kids can get so sick from a seasonal flu.
Would you know if her monocytes, and lymphocytes disappeared?
Would she have gone into DIC? If either if these things occurred, is this a result of septic shock and have you seen this from influenza before?
It is all so puzzling, but to me very fascinating though sad for this child and her family. Did this child have an underlying condition that could have predisposed her to such an devastating event?
I am guessing that your kid has H1N1, the same virus as in 1918 since she is so sick. This is a subtype of influenza A.
| | No. 24 |
Jan 07, 2007, 12:40 AM
Re: 6 Alabama kids were on life support with flu
indigo girl, I really don't know that much about her. She came in while I was on my days off, and when I went back I was in a different area of the unit and wasn't really able to learn that much. From what I can gather, she didn't appear to have any underlying problems; she's never been admitted to our unit before and she's not a little kid, she's an adolescent. I might be able to shed some more light on her on Tuesday; I'm working a day shift on Monday and can try to find out about her differential and the DIC question too. But I don't think she was in DIC when she went on ECMO and now she's anticoagulated, so who knows... I'll also try to find out if they've ID'd the strain.
Last year we had a kid with many underlying problems (including a mitochondrial disorder) who developed septic shock from the flu. He came into hospital the middle of February and coded on Valentine's Day. We got him back and kept him "going" until March 3. He had infarcted his bowel and was again in septic shock. At the insistence of his parents he went to the OR where he was opened and closed; half an hour after he returned to PICU he was taken off life support and died within seconds. It was heart-wrenching. He lived in my neighbourhood and I'm always fearful of running into his parents because I don't know what to say to them. He was their world. That's the worst part of working in PICU... helping parents say goodbye.
| | No. 25 |
Jan 07, 2007, 10:51 AM
Re: 6 Alabama kids were on life support with flu Originally Posted by janfrn indigo girl, I really don't know that much about her. She came in while I was on my days off, and when I went back I was in a different area of the unit and wasn't really able to learn that much. From what I can gather, she didn't appear to have any underlying problems; she's never been admitted to our unit before and she's not a little kid, she's an adolescent. I might be able to shed some more light on her on Tuesday; I'm working a day shift on Monday and can try to find out about her differential and the DIC question too. But I don't think she was in DIC when she went on ECMO and now she's anticoagulated, so who knows... I'll also try to find out if they've ID'd the strain.
Last year we had a kid with many underlying problems (including a mitochondrial disorder) who developed septic shock from the flu. He came into hospital the middle of February and coded on Valentine's Day. We got him back and kept him "going" until March 3. He had infarcted his bowel and was again in septic shock. At the insistence of his parents he went to the OR where he was opened and closed; half an hour after he returned to PICU he was taken off life support and died within seconds. It was heart-wrenching. He lived in my neighbourhood and I'm always fearful of running into his parents because I don't know what to say to them. He was their world. That's the worst part of working in PICU... helping parents say goodbye.
I am so sorry to hear about this other child. I could never, never do the kind of work that you are doing, and I so admire all of you that do.
I find it interesting that the current case is an adolescent as this not the typical age group that usually has such a dire outcome with seasonal flu unless of course there is a prior existing condition.
Would it be correct to assume that this is an isolation case since it is influenza? Sorry to have so many questions, but what type of masks are being used to protect staff?
I would be very interested to hear from any other nurses in PICU if these type of cases come in. Same questions apply. This may be more common than I have been led to believe, but in healthy kids it does seem unusual.
| | No. 26 |
Jan 07, 2007, 02:09 PM
Re: 6 Alabama kids were on life support with flu
Our kiddie from last year, well we didn't mask as a rule with him. He was intubated the entire time he was with us; we use inline suction so the only time the circuit was open was if he needed really aggressive suctioning, then we wore regular isolation masks. Our droplet and contact precautions stipulate masks only when within one meter of the patient or if contact with infectious matter is anticipated. I can't remember anyone getting sick after working with him. I know they aren't routinely masking with our big girl right now either. It's odd that no one else in her family is ill.
We have a supply of N95 masks in a variety of sizes and are fit-tested every year to make sure we have protection. My face seems to change shape year-to-year, so I have to refer to the sticker the infection control people put on my ID card to make sure I have the right one! and of course it's not a "usual" size so they're not kept handy in the unit, but in a storage room. The alst kid I wore one for was a suspected TB, turned out to be plain old RSV, but an atypical presentation.
| | No. 27 |
Jan 07, 2007, 04:44 PM
Re: 6 Alabama kids were on life support with flu Originally Posted by janfrn Our staffing levels are so tight that one ECMO patient strains us to the limit at times.
This is one scary statement. Your health service better start working some flexibility into the program.
| | No. 28 |
Jan 07, 2007, 05:36 PM
Re: 6 Alabama kids were on life support with flu Originally Posted by oramar This is one scary statement. Your health service better start working some flexibility into the program.
Preaching to the choir, honey!! I've just fired off a long and detailed letter to our local union president. I'm thinking I should be going to the BON too...
| | No. 29 |
Jan 07, 2007, 06:02 PM
Re: 6 Alabama kids were on life support with flu Originally Posted by janfrn Preaching to the choir, honey!! I've just fired off a long and detailed letter to our local union president. I'm thinking I should be going to the BON too...
You go, girl!
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BTW, here is another poor little kid from Florida, just 9 years old, my gosh: http://www.sptimes.com/2007/01/05/Ta...r_death_.shtml
Unclear if any prior existing conditions. Maybe it depends on the viral loading dose at exposure. Which viral subtype is it?
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