Flu 2013

Started by alphaholic06
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alphaholic06

alphaholic06

Doctor, Who? Me?
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Are you guys seeing a lot of flu? Not only are we seeing a lot of cases, but it seems to be pretty virulent. We have multiple 20-30 year old patient with ARDS in the unit. Usually the initial flu swab is negative but cultures are returning positive for H1N1. What's happening at your shop?
 
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alphaholic06 said:
Are you guys seeing a lot of flu? Not only are we seeing a lot of cases, but it seems to be pretty virulent. We have multiple 20-30 year old patient with ARDS in the unit. Usually the initial flu swab is negative but cultures are returning positive for H1N1. What's happening at your shop?
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We're setting all types of records. Virulent flu season. We've had a few very sick cases in young pt population.
 
Extremely virulent year out here (TX). Multiple young folks (20s-30s) with H1N1 ARDS. Lots of other not as sick cases too (yesterday had something like 20 cases in 15 hours)
 
Our shop in the upper midwest just started seeing flu in the last couple weeks, but so far our cases have been run of the mill, thankfully.
 
I've been impressed by the predominance of muscle pain I've seen. I'm only an intern, but I've seen people come in crying because of the muscle pain...I mean people writhing in pain.
 
TimesNewRoman said:
I've been impressed by the predominance of muscle pain I've seen. I'm only an intern, but I've seen people come in crying because of the muscle pain...I mean people writhing in pain.
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That's typical for flu, in my experience. If the patient doesn't have myalgias, I doubt the diagnosis.
 
We've had very rare/scattered and not typically ill patients in NE so far, at my place... probably will change in another 2 weeks..
 
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We got hit early in Houston with a bunch of not terribly sick and now not it seems like everybody's coming in after a week of flu sx with bilateral pneumonia and hypoxia. Haven't seen ARDS on presentation like the first wave of H1N1 in 09 but my colleagues have.
 
Not very much in the NW for now. I am seeing more people with "flu-like" (+fever, +myalgias) histories but negative swabs. Either way, no young people have been admission-level sick so far.
 
2 flu admits. 1 due to copd and the other due to pneumonia. Neither critical.
Flu hit oct to early nov here and then abated. Though honestly i stopped testing none sick patients Im sending home
 
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Arcan57 said:
We got hit early in Houston with a bunch of not terribly sick and now not it seems like everybody's coming in after a week of flu sx with bilateral pneumonia and hypoxia. Haven't seen ARDS on presentation like the first wave of H1N1 in 09 but my colleagues have.
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It's happening down here as well. Leukopenia, bandemia, bilateral pneumonia.
Lots of flu B.
 
"Flu and ILI-season" hit early this year down in Florida, but I haven't sent anyone to the unit yet. Lots of Inf-A positive swabs. Not a single B. No idea if they're H1N1.
 
Stitch said:
Just curious on your experience with these patients: how many of the very sick ones got the vaccine this year?
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Worried about coming to Texas?

Most didn't, but a couple of people with vaccine have had flu. None of the ARDS pts though. So, anecdotally, the vaccine prevents bad flu sequelae.
 
Virginia is just getting started and its lots of H1N1 and about half are the really sick variety.
 
Maybe 1 per shift here in CA, but not very sick. Most are DC'ed home. No tamiflu prescribed yet this year. Most have not had many comorbid conditions.
 
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we don't do rapid flu swabs in my ED's... the urgent cares and dr's offices do though. just started seeing real ILI's in the last week or so. prior to that, anything ILI ended up as strep/pyelo/something else. i personally haven't seen any critically ill influenza pts, but heard about a few in the larger system. i'm in NC.
 
The Buff said:
Not very much in the NW for now. I am seeing more people with "flu-like" (+fever, +myalgias) histories but negative swabs. Either way, no young people have been admission-level sick so far.
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Agree. I'm in the Seattle area, and haven't had one positive yet.
 
Dr.McNinja said:
http://www.cdc.gov/flu/weekly/WeeklyFluActivityMap.htm

About Tamiflu though...
http://www.huffingtonpost.com/david-h-newman-md/tamiflu_b_4400584.html

Although Texas DHS wants us to give it to everyone, including negative rapid flu.
http://www.chron.com/news/texas/art...e-flu-cause-of-3-deaths-5084702.php?cmpid=htx
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That's why I stopped prescribing Tamiflu this year (thank you David Newman), or should I say I explain to my patients the actual data on it and ask them if they still want to pay $100 at the pharmacy for it. No one has said yes so far. Especially since all my flu patients this year already had nausea and vomiting as a symptom. I'm usually prescribing Phenergan/Zofran (depends on insurance status), Tylenol/motrin, and chicken soup instead.
 
We've got A and B (inside the polar vortex this week); I've sent all but one home. Agree with lots of c/o myalgias; moreso than I have seen prior. Less snot.
 
Rendar5 said:
That's why I stopped prescribing Tamiflu this year (thank you David Newman), or should I say I explain to my patients the actual data on it and ask them if they still want to pay $100 at the pharmacy for it. No one has said yes so far. Especially since all my flu patients this year already had nausea and vomiting as a symptom. I'm usually prescribing Phenergan/Zofran (depends on insurance status), Tylenol/motrin, and chicken soup instead.
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I've noticed that when I have this discussion with most people their eyes seem to glaze over through the discussion of lack of proven benefit & side effect profile, but as soon as I mention the $100 price tag, they snap out of it and say "no way!".
 
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