The 1918 flu pandemic (January 1918 December 1920) was an unusually deadly influenza pandemic, the first of the two pandemics involvingh1n1 influenza

PANEL DISCUSSION

The 1918 flu pandemic (January 1918 December 1920) was an unusually deadly influenza pandemic, the first of the two pandemics involvingh1n1 influenza virus. [1] It infected 500 million [2] people across the world, including remote Pacific islands and the Arctic, and killed 50 to 100 million of them three to five percent of the world's population [3] making it one of the deadliest natural disasters in human history.

Q: How many people in India have already died in the current H1N1 epidemic, and how many died in the 2009-15 epidemic? 500 & 1000 1500 & 3000 2500 & 5000 10000 & 20000

Q: How many people in India have already died in the current H1N1 epidemic, and how many died in the 2009-10 epidemic? 500 & 1000 1500 & 3000 2500 & 5000 10000 & 20000

Q: Why is it called the Swine Flu? It comes from eating swine It is transmitted to humans from staying close to swine It is a virus that jumped to humans from swine The present strain can infect both humans & swine

Q: Why is it called the Swine Flu? It comes from eating swine It is transmitted to humans from staying close to swine It is a virus that jumped to humans from swine The present strain can infect both humans & swine

Q: How long does the flu virus survive on surfaces? Hard surfaces like steel / wood/ plastics - Porous surfaces like cloth / tissues etc - On hand / skin -

Q: How long does the flu virus survive on surfaces? Hard surfaces like steel / wood/ plastics - Upto 48 hours Porous surfaces like cloth / tissues etc - Upto 12 hours On hand / skin - Few minutes Most likely mode of transmission

Q: When to suspect swine flu? Fever Cough Sore throat Chills & fatigue Diarrhea and vomiting Headache Body aches & joint pains Rhinorrhea

Sub clinical infection: Almost 30% cases get no symptoms! Common cold (Rhino-pharyngitis): Majority of other patients develop a disease no different than an ordinary cold & recover with simple fever and cough medications. Tracheo-laryngo-bronchitis (Croup): These patients have fever, hoarseness of voice and significant cough. H1N1Pneumonia: Only 3-5 cases out of 100 H1N1 cases develop this level of disease.

Q: What is the most specific symptom for Swine Flu as compared to other types of Flu, that can help you suspect this in a particular individual? NONE

Q: How soon will I get sick if I am exposed to the flu? 1-4 days 5-7 days 10-14 days 14-21 days The time from when a person is exposed to flu virus to when symptoms begin is about 1 to 4 days, with an average of about 2 days.

Q: For how long does an individual remains infectious? What is the time of maximum viral shedding? 1 day before to 7 days after. Max viral shedding on day 1 of illness

Q: Who should be investigated? A. Priority for testing should be given to: 1. Those who require hospitalization; 2. Those who are at high risk for severe complications

Do all suspect cases need to be tested? Should all suspected/confirmed cases be hospitalized? Should all suspected/confirmed cases be treated with antivirals?

Q: Where are the diagnostic facilities available? There are standard laboratories for testing A (H1N1) in the entire country. Samples are collected at district hospitals of different states and send to nearby IDSP/ICMR centers having facility for Influenza virus testing.

Category Presentation Testing for H1N1 A Mild fever plus cough / sore throat with or without bodyache, headache, diarrhoea and vomiting B Signs and symptoms of Cat. A + High grade fever, severe sore throat, Or Cat-A signs & symptoms with high risk conditions* Hospitali zation Oseltamivir administrat ion Treatment modality No No No Home treatment No No Yes Home confinemen t C Signs and symptoms of Cat. A & B + breathlessness, chest pain, drowsiness, hypotension, bloody sputum, bluish discolouration of nails; convulsions, Or signs and symptoms of Cat. A & B +worsening of underlying chronic conditions Yes yes Yes Immediate hospitalizati on

AVAILABILITY OF SWINE FLU TEST AVAILABILITY OF DRUG

AVAILABILITY OF ISOLATION BED FACILITY HOSPITAL MANAGEMENT SUPPORT FEAR OF STAFF AND FELLOW DOCTORS

Dose of Oseltamavir Steroids Bronchodilators Other Ancillary therapies

No official definition PaO2 < 50 on an FIO2 = 1.0 Persistent for > 1 hour Despite PEEP trial of up to 20 cm H2O Despite ruling out readily reversible causes Mucus plugging/lobar or greater collapse Pneumothorax Systemic vasodilators enhancing shunt Pulmonary embolism Intra-cardiac R > L shunt Circulatory collapse (low SvO2)

First Approach to hypoxemia NIV Invasive Ventilatory Strategy Compliance Issue

First Approach to hypoxemia NIV Invasive Ventilatory Strategy Compliance Issue

PEEP/ Recruitment Strategies Proning Diruesis+/ Albumin Newer modes

HFOV ECMO

Package 1 ALWAYS Reassess goals of care Reassure self of outcomes of refractory hypoxemia Eliminate reversible causes of hypoxemia PEEP trial (UP? DOWN?) Consider diuresis Massive resusc consider chest tubes and abdomen

Package 1 ALWAYS Reassess goals of care Reassure self of outcomes of refractory hypoxemia Eliminate reversible causes of hypoxemia PEEP trial (UP? DOWN?) Consider diuresis Massive resusc consider chest tubes and abdomen Package 2 Usually Recruitment maneuver Therapeutic trial of paralysis Prone Violate Pplat criteria for LPV

Package 1 ALWAYS Reassess goals of care Reassure self of outcomes of refractory hypoxemia Eliminate reversible causes of hypoxemia PEEP trial (UP? DOWN?) Consider diuresis Massive resusc consider chest tubes and abdomen Package 2 Usually Recruitment maneuver Therapeutic trial of paralysis Prone Violate Pplat criteria for LPV Package 3 Rarely ino or inhaled prostacyclin HFOV???? ECMO-Most likely to be used nowadays

All patients with ALI should be on lung protective ventilation Refractory hypoxemia is never missed None of the treatments that improve oxygenation have been shown to affect mortality over a large cohort Deaths from hypoxemia are very rare and side effects of hypoxemia unclear

PEEP Pee (diuresis) Prone Paralysis Pleural evacuation Prostacyclin (or ino) More Peep

Q: How soon does Flu vaccine start protecting against Flu? 3 days 7 days 10 day 14 days

Q: Do all the available flu vaccines provide protection against current outbreaks of A (H1N1)? Yes / No / Maybe

Q: What is the overall efficacy for flu vaccines when strains are well matched / this year? 70-80 %/ 20 % 50-60 % / 30 % 40-50 % / 40 %

That s all folks!

IN VIEW OF NEED OF VENTILATOR IN VIEW OF LENGTH OF STAY IN VIEW OF HYPOXIA IN VIEW OF MULTIORGAN FAILURE IN VIEW OF YOUNG PATIENT COMPARE TO OLD AGE? IN VIEW OF HEALTH VICTIM VS VICTIM WITH COMORBIDITIES

IN VIEW OF INVASIVE VS NON INVASIVE IN VIEW OF MODE SELECTION IN VIEW OF USE NEWER MODES IN VIEW OF USE ECMO

UR COMMENT ABOUT NEED OF SWINE FLU VACCINE? WHEN AND TO WHOM V SHOULD OFFER? DO U FOUND ANY PROBLEM WITH SWINE FLU VACCINE? NASAL VS IM ROUTE

ANY NEW USE STRETERGY FOR PREVENTION OF SWINE FLU TO PARAMEDICAL STAFF AND MEDICAL STAFF ROLE OF VACCINE ROLE OF PPE.

STEROID IN SEVER ARDS IN SWINE FLU PT NEWER ANTIVIRAL SUPPORTIVE DRUG IN Mx

INFLUENZUM VACCINE USE OF KAPOOR