No Prior Existing Conditions but Dead Anyway

[indigo girl]

http://www.todaystmj4.com/news/local/48007842.html

Who would think that a normally healthy woman would die so swiftly from influenza in June?

Could you ever have imagined such a thing? No wonder her family and friends are in shock.

So why did it happen?

Barbara Davis, 48, was healthy just a week ago. She had dinner with her mother Josephine last Friday night. But just hours after that dinner, Josephine got a phone call.

"My friend, he called me and told me Barbara was real sick. And I said, "Well, she wasn't sick when I left, so what's the matter?" Josephine Davis said.

Barbara told her mother that she was ok. But the next day, things got worse. She had trouble breathing, and she was shaking. She could barely walk into the hospital.

"She tried to talk to people, but she just couldn't talk," Josephine Davis said.

Doctors treated her for two days, but they couldn't save her. They believe she died from swine flu.

"They've never seen nothing like that, what she had. That infection just went through her body, attacking her kidney, her lungs, her liver. Everything," said Josephine Davis.

The Milwaukee Health Department confirmed on Friday a Milwaukee adult with no underlying medical conditions died from swine flu, though they haven't confirmed Barbara Davis was that victim.

Barbara's family knows all too well how serious swine flu can be.

"Everybody is just in a shock. The people that I talked to today, they are frightened. Because it happened all of a sudden," Josephine Davis said.

More than 1,800 people have caught swine flu in Milwaukee alone. The city's Health Department is stressing that if you are mildly ill with flu symptoms, you should call your doctor. If your symptoms are serious or if you have mild symptoms that are getting worse, you should see a doctor right away.

http://www.wisn.com/health/19751526/detail.html

The Milwaukee County Medical Examiner said 48-year-old Barbara Davis died Thursday in the ICU after being diagnosed with the flu strain.

The health department said, unlike Milwaukee's first swine flu victim, Davis did not have any "underlying medical conditions" that would have put her at a greater risk for the disease.

http://www.flutrackers.com/forum/showpost.php?p=248304&postcount=7

This post was written by Dr. Gratten Woodsen, MD commenting over at flutrackers on this unfortunate woman's case.

The decedent is described as having fulminate multi-organ failure that developed rapidly resulting in death 48 hours after onset and despite intensive medical therapy in an ICU including all the bells and whistles.

The attending physicians told the mother that they had never seen anything like this before and I believe them. So did she. No one has seen anything like this since 1918. In 1918 many doctors said the say thing after dealing with their first cases of Spanish Flu and for them too it was a great surprise at least until those that didn't die from the virus themselves had seen it so many times that it was no longer unique.

There are numerous descriptions from the 1918 pandemic that match the one above but no where else in medical history do we find anything remotely similar. This is why the doctors in Milwaukee were so shocked by what they saw.

How many other North American victims had similar pathology? Why have the autopsy and clinical findings from the deaths in Mexico, the US and Canada been suppressed?

I know from press reports that there have been other US deaths where multi-organ failure was present. Is this common among those who have died of Swine Flu or rare? Are the findings similar to those seen in 1918 or not?

(hat tip flutrackers/skatman)

[lamazeteacher]

our sole documented h1n1 death to date was also a combination of mrsa toxic shock and h1n1. the media is reporting that this child had pre-existing health problems, but the only thing other than the flu that she had was mrsa, suggesting community-acquired infection. (our nosocomial multi-drug resistant organism rates are extremely low. probably that is to to the faulty thinking that the unit has to have a patient there with mrsa, to make a nosocomial infection report, ignoring the fact that some nurses and visitors may carry that pathological, dangerous bug.....at the time of her admission we had no mrsa positive patients on the unit.) did a blood specimen get sent for culture when she was admitted, to rule out community acquired mrsa? she was treated with appropriate antibiotics was the dosage checked, to be sure adequate amounts were given? but the combination of pathogens created a situation that resulted in complication after complication until she was removed from ecmo and died.

while i realize that some h1n1 patients can progress quickly to irreversable conditions without mrsa muddying the field, it would help the perception of nosocomial infection rates, if baseline tests for mrsa were taken upon admission to icus (when another stick isn't necessary, and there might be time to halt the synergistic process of that lethal combination).

are antivirals being used in icu withb h1n1, or are patients getting there later than 48 hours after commencement of symptoms, obviating the use of them?

[NotReady4PrimeTime, RN]

We swab everyone who has been transferred from another facility, including the child I mentioned. Blood cultures were sent on admission and were positive for MRSA within a day. We monitor drug levels for many antibiotics routinely even though our lab doesn't like it when we do it, and we especially monitor them for patients on ECMO because the circuit slurps up a lot of drugs. Her vanco dose would have been therapeutic as would her linezolid and rifampin. We also have constant surveillance by our infection control department with daily visits from the IC NP. Our ECMO patients have daily blood cultures drawn from both the patient and the circuit and antimicrobials are adjusted accordingly.

Our hospital doesn't worry about the 48 hour thing. If we have a suspected influenza A they get oseltamivir within an hour of the admission orders being written.

[lamazeteacher]

Jan, I appreciate your full response and quality of care; and all the work you've submitted to keep us at allnurses.com, up to date! Even though I'm 70 and not gainfully employed right now, I hate to miss anything coming down, or up the pike.

Sounds like you work in Canada, as I have (eons ago). I'm so proud, seeing what you do, taking responsibility for continuing the education of all nurses.

Your health care system's anticipation of the need for ECMO is admirable, but somehow, someone dropped the ball...... does that happen frequently? I'm interested in knowing, due to the U.S. government's approaching involvement in our health care.

[indigo girl]

Powell, Wyoming

http://powelltribune.com/index.php/content/view/2808/2/

Influenza has been confirmed in the death of Kerby Brandon of Powell, 47. Brandon was hospitalized at Powell Valley Hospital on Nov. 10 and life-flighted the following day to St. Vincent Healthcare in Billings. He died there on Friday.

State Epidemiologist Dr. Tracy Murphy confirmed Brandon's death was the 10th fatality in Wyoming caused by influenza since the first case of H1N1 was diagnosed in the state in May. Nine of those were from influenza A, all of which are believed to be novel H1N1, Jamieson said.

A news release from the Wyoming Health Department on Wednesday said Brandon had no identified underlying medical conditions that put him at greater risk complications from influenza.

(hat tip pfi/aurora)

[NotReady4PrimeTime, RN]

Your health care system's anticipation of the need for ECMO is admirable, but somehow, someone dropped the ball...... does that happen frequently? I'm interested in knowing, due to the U.S. government's approaching involvement in our health care.

Thank you for your kind words. Don't apologize for trying to keep current. As long as you're learning you're living.

Now how to explain about out health care system... I know you have some knowledge of Canada and its idiosyncrasies, but I'm not sure how much you know about Alberta. It's roughly the size of Texas with a population of about 3.7 million. Most of the population is clustered in about a dozen cities. The northern third of the province has some far-flung communities with small populations, rough terrain and a forbidding climate. The middle third of the province contains most of the people and the southern third is ranchland. There are some large aboriginal communities in different parts of the province.

Health care in Canada is a federally regulated, provincially administered service. In Alberta the system has been overhauled and retooled several times. In the early 90's we went to a regional model where each of 15 regions had their own administration, their own budgets, their own priorities and their own facilities. Each region functioned independently while reporting to the minister of health and his assistants. Some regions, like Capital Health, were very successful at managing their money and resources. Others struggled t find the right balance but in general things worked. Services that weren't available locally were provided by another region; for example, trauma care for northern Alberta was provided by Capital Health and in southern Alberta by Calgary Health Region; transportation costs were picked up by the province. Capital Health had built itself into one of the most advanced and successful health regions in the country. About a year ago our government decided to restructure the system they restructured in 2003 when they reduced the number of regions from 15 to 9. This restructure took those 9 regions and made us all one big happy family. The regional administration was eliminated at great cost and an interim team put in place. The massive centralization was finalized on April 1. All the financial resources were pooled, all the human resources were now employees of Alberta Health Services and an Australian economist was hired as president and CEO. The focus shifted from clinical excellence to fiscal constraints. A serious nursing shortage was eliminated overnight by the stroke of a pen with the introduction of a vacancy management program, doublespeak for a hiring freeze. Bed closures have been announced at most major hospitals and layoffs to management and other non-clinical personnel followed. Wages are frozen and "revenue-generation" is in full flux. Virtually every decision in the province had to cross the president's desk... and he introduced a documentation-heavy process for all requests. The notion of economies of scale has value but not when it's taken to the dogmatic extreme we're seeing.

When the information coming from the southern hemisphere and Europe began pointing to an increased need for ECMO resources to treat novel H1N1, given that our hospital has a very active ECMO program, it was suggested that we increase our capacity to be ready to manage the surge. The medical director of our ECMO program filed all the required paperwork in plenty of time to have the team expanded and the equipment purchased. The paperwork then went to the critical care program director who had to think about it for a few weeks, then to the site director for another period of pondering. Then it moved on to the zone director who assessed its value before sending it on to the president for his approval. It would have arrived on his desk around the time he was on vacation in France for 2 1/2 weeks. (On the job fewer than four months and already on vacation, he wasn't too popular with the staff members who will never be senior enough to have vacation time in the summer.) When he returned he was caught up in visiting all the hospitals in the province to offer up his Koolaid. Then he flew back to Australia to attend an awards dinner in his honor. So by the time the approval was granted and the equipment ordered, it was already late summer. And there you have a recipe for ball-dropping on a grand scale.

My apologies to the other readers of this thread who have managed to work their way through this lengthy tale of woe.

[indigo girl]

Chelsea, Michigan

http://www.annarbor.com/news/dexter-area-family-of-h1n1-victim-talks-about-loved-one/

Rob Darrow, 48, died last Sunday from complications related to the swine flu, or H1N1 flu, after spending two weeks in the University of Michigan's intensive care unit.

Rob Darrow had no underlying illnesses and had barely been sick a day in his life, Sandy Darrow said. He was not part of any high-risk group given priority for the swine flu vaccine.

(hat tip pfi/monotreme)

[indigo girl]

Sioux Falls, South Dakota

http://www.keloland.com/News/NewsDetail6374.cfm?Id=93117

Newville's family issued the following statement about his death:

Tyler was happy, healthy active 12-year old who had no underlying health issues. He started running a low-grade fever Wednesday night. He stayed home from school Thursday with typical, mild flu-like symptoms. Friday morning his fever broke, but his breathing was becoming labored. He was taken to Sanford Clinic and from there, he was taken by ambulance to Sanford Children's Hospital where he was admitted to the intensive care unit. At the children's hospital, he was diagnosed with H1N1, pneumonia and severe shock. Because of the shock his body was not able to respond to treatment the way it should, and despite the huge effort of all the doctors and nurses, he passed away at approximately 6:30 p.m. Friday.

We want to stress to everyone the importance of getting immunized and taking every precaution to prevent getting or spreading H1N1.

(hat tip flutrackers/RoRo)

[lamazeteacher]

Since no mention of family members becoming ill with H1N1 simultaneously, or after losing the posted relative, it seems that it's the host, not the bug that's responsible for rapid demise.

I read somewhere that one person's immune defense, due to invasion by viruses; whereas someone else's immunity functions well. No reason for the difference has been determined, although theoretically, immunization could increase the defensive cellular reaction with the antibodies against the virus that have been produced during the 3 weeks following vaccination.

Has anyone else read of conclusive studies comparing those exposed to H1N1 by a close family member who was severely ill (enough to require ICU care), yet the other family

member(s) didn't become that ill? It might make an argument regarding immunization advantages possible, or some other preventive action.

[indigo girl]

Peterborough, Ontario

http://www.thepeterboroughexaminer.com/ArticleDisplay.aspx?e=2189323

...Traviss has H1N1, influenza A and pneumonia in both lungs. There's an area on each of his lungs, about the size of a toonie, that's working properly, doctors have told them.

Some organs, such as his kidney and liver, are shutting down because they're not getting enough oxygen. No one's sure if he'll come out of the coma.

His family says he's the kind of man who rarely gets sick-he's a non-smoker who keeps in shape with his job as a truck driver, often hauling bags of cement, and he chops his own wood for his home's fireplace. They say he has no underlying medical conditions.

(hat tip flutrackers/Roehl_JC)

[indigo girl]

Duluth, Minnesota

http://www.parkrapidsenterprise.com/event/article/id/20876/

Matthew James Walczynski, 32, of Duluth came home from work Friday, Nov. 6, running a fever of 103.8 degrees, and went straight to bed, according to his mother. Ten days later he was dead.

He’s one of six people who have died in recent weeks at SMDC Medical Center in Duluth because of flu-related ailments, even as the number of flu patients has dropped across the Northland. Walczynski, a quality analyst for Optium Health, was the only one of the six who didn’t have an underlying health condition before he came down with the flu, SMDC officials said.

Dr. Kevin Stephan, an infectious disease specialist at SMDC, said he has not heard of any other H1N1 death in the state involving an adult with no prior underlying medical issues that would place them at risk.

(hat tip pfi/monotreme)

[indigo girl]

Alliston, Ontario

http://www.simcoe.com/article/150466

David Alexander, 53, died on the weekend at Toronto General Hospital. His son John Alexander said doctors were almost 100 per cent certain he had the H1N1 virus.

...doctors determined he needed a procedure called an ecmo.

A few days before entering hospital, he experienced shortness of breath but his family didn't suspect swine flu. It progressed quickly and he died after a week in hospital.

Alexander said his father was healthy and had no underlying health problems.

(hat tip pfi/pixie)

[indigo girl]

Cumberland, Rhode Island

http://www.woonsocketcall.com/content/view/114187/1/

Health officials have confirmed that a Cumberland man's death on Sunday was "H1N1 related," said Annemarie Beardsworth, spokesperson for the Rhode Island Department of Health.

Health officials are not releasing the identity of the victim. The man was between 50 to 60 years old with no underlying medical conditions, Beardsworth said.

(hat tip pfi/monotreme)