H1N1

Yes, I have! Have had three cases where nephrology was consulted while I was on duty. Its totally weird too: 2 of the 3 were morbidly obese (BMI >35) females who's only issue was DM (and it was controlled). Both are recovering, though slowly.

I was on call this weekend and saw one pt with the intensivist and he said in the latest JAMA, there is an article that there is a 30% mortablity rate for morbidly obese pts.

Obviously, when we get consulted, we are at the end-organ system failure.

We've had around 15 confirmed cases. 5 got sick enough to need ICU/intubation. We treat with Tamiflu liberally for 10 days per ID recommendation. We've probably screened another 50-60. Found a few RSV cases that way. Seems to be dying down for now. Slight uptick in Season Flu.

David Carpenter, PA-C

We've had 3 confirmed cases, fortunately with relatively mild illness. Treated with Tamiflu for 10 days like David said.

Was it suspected or just part of the workup?

We do a respiratory viral panel on any suspected cases. The interesting thing is that at the height we had a couple of cases without any respiratory symptoms. They had GI symptoms and someone accidentally did a respiratory viral panel which came back positive. We found two more cases by checking everyone with GI symptoms (around 15% at the time). This probably reflects the immunsuppressed population. We get all of our cultures back in two days. The RSV comes back at one day then the full panel comes back in two days. We stopped using the rapid culture after we had a 50% false negative rate in the first 10. Easier to just put them on respiratory isolation for two days then take it off if negative.

We are now pushing to vaccinate all of our patients. Our ID specialists are worried that we are going to have a second round that is worse in the spring.

David Carpenter, PA-C