Pandemic Home Care Options

Preparing for Pandemic Flu has some of it's own issues and concerns.
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Readymom
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Pandemic Home Care Options

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The following is an excerpt from the blog site of a former paramedic, who was heavily involved in the public Health Response to the `Swine Flu' threat of the 1970's. After a brief introduction explaining the initial impact of a global pandemic in the sheer number of seriously ill with Avian Influenzia, Fla_Medic goes on to say:

Avain Flu Diary

Pandemic Home Care Options
http://afludiary.blogspot.com/2006/12/pandemic-home-care-options-258-word.html

  • The bottom line is, if you or a family member contracts the avian flu,
    you will probably have to ride out the illness at home, under the care
    of your immediate family. Given the numbers, there really isn't much
    choice.

Please go to his blog at http://afludiary.blogspot.com/ to read a comprehensive and bold idea regarding home care of those individuals we my be faced with caring for in our own homes, during a period of 'sheltering-in-place', entitled 'Pandemic Home Care Options, #258' ... http://afludiary.blogspot.com/2006/12/pandemic-home-care-options-258-word.html
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x-Home Care of Flu Patients-How To

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How to Care for Someone with Influenza
https://www.kingcounty.gov/depts/health/emergency-preparedness/preparing-yourself/pandemic-flu/individuals-families/~/media/depts/health/emergency-preparedness/documents/pandemic/care-for-someone-with-influenza-EN.ashx

Seattle & King County Public Health

Introduction:
During a severe influenza outbreak or pandemic, the media and healtcare providers will notify residents of King County with instructions for obtaining medical advice and receiving medical care. The following information is a general guide and is not intended to take the place of medical advice from a healthcare provider. ---CONTINUED---



Edited for updated link
Last edited by Readymom on Wed Jun 27, 2007 1:35 pm, edited 1 time in total.
Readymom
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Home Care of Flu Patients-Red Cross PDF Flier

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Home Care for Pandemic Flu
https://burgess.house.gov/uploadedfiles/american%20red%20cross%20-%20pandemic%20flu%20home%20care%20brochure.pdf

Red Cross Home Treatment Flyer 2 pages - May 2006 - .pdf

Topics covered:
~ What is Pandemic Flu
~ Prevent the Spread of Pandemic Flu
~ When a Household Member is Sick
~ Practice Hand Hygiene
~ Recognize Pandemic Flu Symptoms
~ Care for the Loved One With the Flu
~ Monitor Pandemic Flu Symptoms
~ Prevent Dehydration
~ Reduce Fever
~ Prepare for a Flu Pandemic
Readymom
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Doctor Recommended Rx Protocol for Avian Flu

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* Link Unavailable. This site is no longer active and available to view on line. But the info was good and we wanted to keep sharing it!

Okay gang, this is something I've been lucky enough to fall into. An MD whom I respect has graciously provided me with his thoughts on the home treatment of avian influenza. It's an agressive protocol, but I think it's a darn good one.

Fair Warning: IT ASSUMES YOU HAVE RX MEDS. Maybe you have some of them, maybe you have all of them. If you don't have any of them, Maybe you can use this information to convince your personal physician into writing a script or two.

In any event, I'm protecting the identity of the doctor. Don't even ask. He's gone out on a limb doing this for us. Use it at your own risk. Or don't use it. Entirely up to you. But you're gettting to see something here that 99.999% of the world will never see. What a doctor really thinks should be reasonably done for an avian flu patient at home.

One last thing. The caveats included are serious. Read the whole document. Understand there are risks involved in any therapy. Seek medical attention, and the advice of your family physician when ever possible.

Hope you find it useful, and that you never actually need it.


Fla_Medic
______________________________________________________________

Avian Flu: Diagnosis & Treatment in a Home Setting

Over the past several months I've been in close communications with a doctor in the UK who has provided me with his thoughts on the home treatment of avian influenza. None of what follows should be construed as specific medical advice, and it is presented for educational purposes only. Consult your own doctor before deciding on any treatment protocol.
Recognizing that hospitals will likely be overrun in a pandemic, he prepared a treatment guide, and forwarded it to me. I’ve taken his advice, and have converted some of the European medicines to American equivalents, and have translated some of the medical lingo into more simplified terms. I've also added some caveats of my own, as this information was originally intended for someone with a bit of a medical background.

NOTE: This is one doctor's opinion, based on currently available information, and assumes the treatment of an otherwise healthy adult of 70kg (154lbs), under the age of 65.

DIAGNOSIS OF AVIAN FLU

The presumption is that avian flu has broken out, is easily transmissible, and has been reported in your community. The signs of avian flu are very similar to other influenzas, and cannot be differentiated without lab tests. However, in a pandemic situation, lab tests will not be available, and a diagnosis will have to be made on clinical signs and symptoms alone.

Clinical Diagnosis of Avian Influenza(WHO/HPA)
1. Fever >38C (101.4 F)
2. Cough.
3. Sore throat
4. Runny nose
5. Muscle aches
6. Conjunctivitis (red, burning, itching eyes, may have exudate)
7. Gastrointestinal symptoms including abdominal pain, diarrhoea and vomiting
8. Short of breath with tachycardia(rapid heart rate) or bruising or peripheral cyanosis/hypoxia(bluish tinge of skin around fingers, toes, lips)

Low risk: any two from 1-6
Medium risk: low risk + # 7
High risk: medium risk + #8 (advanced case)

Child assessment for assessment.

If any of the following admit to hospital immediately if possible. Please remember that children's conditions alter suddenly, not gradually as in adults.

Cyanosis. Blue tinge in skin anywhere
=Dehydration. Poor skin texture, poor urine output
=Altered consciousness.
=Seizures.
=Signs of sepsis. Cold skin/ very hot skin, low blood pressure, pulse rate slow
=Respiratory distress. Rapid breathing, use of accessory chest wall muscles(also neck muscles).


Home Treatment of Avian Flu

The essence to this regimen is speed of diagnosis and speed of initiation of this regimen. Once a reasonable assumption of avian flu infection has been made, it is imperative to begin treatment at the earliest possible moment. The virus replicates rapidly, administration of antivirals in the first 24-48 hours may be lifesaving.

Start Antiviral agents

Tamiflu: 150mg bd (twice daily) for first 3 days, and 75mg bd (twice daily) thereafter for a total of 7 days (unless you have the supply to continue for 150mg bd (twice daily) for seven days)

Amantadine: 200mg bd (twice daily) for first 3 days and 200mg thereafter for a total of 7 days (unless you have the supply to continue for 400mg daily for seven days)

Probenicid: 500mg daily for 7 days (this increases the blood concentration of the antiviral medication)

The idea of this regimen is to minimize the viral replication and as such the viral load early in the disease process.

For a 70kg Adult, this would require between 20 and 28 Tamiflu capsules over 7 days. The dosage should be adjusted by weight for younger, smaller patients.

Between 20 and 28 Amantadine Capsules over 7 days. And 7- 500mg Probenecids.

Notes: Frontloading the antivirals and at heavier doses is not part of the generally recognized treatment strategy (10 pills over 5 days) as espoused by health authorities. It does have certain advantages, and a number of doctors I've spoken to believe it to be a more effective method of treatment. It does run a higher risk of side effects, particularly from the Amantadine. Patients should be monitored carefully for any adverse effects of these medicines, particularly children, those over the age of 65, and those with renal impairment.

The most frequent side effects associated with Amantadine include dizziness, loss of coordination, inability to sleep, and nervousness, nausea, and vomiting. All of these side effects have been reported to occur in about 1 in 20 persons. Effects can appear after a few hours or several days of therapy. Less common side effects include headache, irritability, nightmares, depression, confusion, drowsiness, and hallucinations, weakness, amnesia, slurred speech, diarrhea, constipation, and loss of appetite, and discolorations in the eye. These side effects are greater in the over 65 year age group, and as such the dosage should be half that of under 65 year old patients.

Probenecid, a gout medicine, slows the excretion of certain medicines from the body. It can essentially double the time some medicines remain in the body. This can be a tremendous plus when dealing with antibiotics and anti-virals, but could cause problems with other medicines. If you are taking other prescription medicines, discuss with your doctor the effects taking probenecid might have on those medications before using it.


CYTOKINE STORM

There has been considerable concern of the possibility of the 'cytokine storm', which is commoner in the 15 to 35 year old group hence:

To minimise the risk of cytokine storm start:

Simvastatin (Zocor) 40 mgs daily for 7 days

Non-steroidal anti-inflammatory agents. These not only work as a good antipyretic (fever reducer) , they also reduce the risk of cytokine storm. The commonly available NSAID include Ibuprofen (400mg tds) and diclofenac (50 mg tds).

Continue for 7 days.

Nausea/Diarrhea/Vomiting

These symptoms may occur as a result of the influenza virus, or from the medications. In either event, they can interfere with the treatment, and need to be controlled. Vomiting and diarrhea cause fluid loss, and dehydration. Vomiting can also cause the loss of precious medications.

Promethazine (commonly called Phenergan) 25mg bd (twice daily) can be administered for the duration of the antiviral agents. It is available in an oral, and a suppository form.

Kaolin (Kaopectate) (Yes very old fashioned but still effective) 10ml qds (4 times a day) for the duration of the diarrhoea

Loperamide (Imodium): 2mg tds (twice a day) for the duration of the diarrhoea.

Rehydration, using ORS solution, is very important for anyone with fluid loss.

Anti-Pyretics (Fever Reducers)

Tylenol 500mg , up to 8 per day( either orally or rectally in suppository form)

Antibiotics

As it has been noticed that some patients have died of secondary bacterial infections within the first 5 days of onset of the disease, a broad-spectrum bactericidal antibiotics should be used from day 1 to day 7

Co-Amoxiclav (Augmentin) 375mg tds (3 times a day) , or erythromycin 500mg qds (4 times a day) for one week (erythromycin is bacteriostat at lower doses).

Note: I've spoken with this doctor and asked about alternative antibiotics, including Cipro, Zithromax, and Doxycycline, all of which he feels are reasonable substitutes. Comparable doses of these medications are:

Cipro: 500mg bds (Twice a day) for 7 to 10 days

Zithromax: Day 1: 500 mg Days 2-7: 250 mg

Doxycycline: 100mg bds (Twice a day) for 7 to 10 days

There are other less proven medication regimes which may help, and often will cause no harm in trying, appreciating the alternative.

Nebulisation with betaagonists (Salbutamol (albuterol) and Terbutaline). This may open the airways, but monitor the pulse rate as tachycardia is a complication of excessive use.

Oral steroids: Do they help to suppress the cytokine storm? We do not know, but if you try, aim for 60mg a day in divide doses. Prednisone and Prednisolone are two oral steroids that have been suggested.

Other useful facts.

Treat any conjunctivitis with 1% chloramphenicol eye drops or fucithalmic acid tds (three times a day)

Assume that after 7 days, the patient may still be susceptible to secondary bacterial infections, so continue to monitor pulse and temperature- these will be the first indices to rise. Be prepared to resume, or continue antibiotics.

Stop Clopidogrel (Plavix), it blocks the effect of Tamiflu

Stop Beta interferon (used generally for M.S. patients), as it enhances the cytokine storm.

Adjusting Dosages & Dealing with Missing Medications

Dosages recommended are for a 70 kg adult, under the age of 65, without concurrent health problems. Those with kidney problems, or those over the age of 65, may need to reduce the dosage by as much as half, particularly on the Amantadine. Discuss your particular needs with your family physician in advance. Don't guess!

Generally speaking, you can take the milligram/body weight dosage and adjust downward for teenagers and children down to the age of 8 or 10. A 75 lb child of 10 would require roughly half the dose of a 150 lb adult.

These medication recommendations are likely in excess of what most people will have available. However, use what you have. If you don'=t have Tamiflu, but do have Amantadine, you still have a powerful anti-viral in your arsenal. Antibiotics, or even ORS and Tylenol can be life saving.

Always monitor the patient, take vital signs, and keep records. Be prepared to alter the treatment if the therapy appears to be doing more harm than good.
_________________
All medical discussions are for educational purposes only. I am not a doctor, and nothing I post should be construed as medical advice. Additionally, anything I post is my own opinion, and not necessarily that of the management.
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HHS: Home Health Care During an Influenza Pandemic

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Home Health Care During an Influenza Pandemic: Issues and Resources
https://altarum.org/sites/default/files/uploaded-publication-files/homehealthcare2008.pdf

Prepared for:
Agency for Healthcare Research and Quality
U.S. Department of Health and Human Services
540 Gaither Road,
Rockville, MD 20850


Contract No. 290-04-0010

Editors

Ann Knebel, R.N., D.N.Sc., FAAN
Office of Preparedness and Emergency Operations
Office of the Assistant Secretary for Preparedness and Response

Sally J. Phillips, R.N., Ph.D.
Public Health Emergency Preparedness Research Program
Agency for Healthcare Research and Quality

July 2008
AHRQ Publication No. 08-0018

What to Expect During a Pandemic. In the event of an influenza pandemic, because of anticipated shortages of health care professionals and widespread implementation of social distancing techniques, it is expected that the large majority of individuals infected with the influenza virus will be cared for in the home by family members, friends, and other members of the community – not by trained health care professionals. Given these circumstances, home health care workers can expect to be called on to provide care for two main populations of patients: ---CONTINUED---

Contents

Executive Summary

Chapter 1. Introduction
The Context
Overview of the Home Health Care Industry
What to Expect During an Influenza Pandemic

Chapter 2. The Need for Community Collaboration and Business Continuity
Role Clarification
Identifying Community Partners
Internal Readiness Assessment
Supplies and Equipment
Reimbursement
Information for Community Planners
What Is Needed

Chapter 3. Understanding the Community Planning Process
Tests and Exercises
Command and Control
Communication
Models of Effective Collaboration with Home Health Care
What Is Needed
Further Resources

Chapter 4. Addressing Workforce Issues
Recruitment and Retention
Ability of Health Care Workers to Report to Work During a Pandemic
Willingness of Health Care Workers to Report to Work During a Pandemic Workforce Training Needs for an Infuenza Pandemic
What Is Needed

Chapter 5. Changes in Parameters of Patient Care
New Patients and New Needs
Supporting Patient Care with Telehealth Technologies
What Is Needed

Chapter 6. Legal and Ethical Concerns
Declarations of Emergencies
Key Legal and Ethical Issues
What Is Needed
Further Resources

Chapter 7. Conclusion

Recommendations for Further Research
Recommendations for Action at the Federal, State, and Community Levels

Appendix A. AHRQ Home Health Care in Pandemic Influenza Expert Panel Participants
Appendix B. Home Health Care Services pandemic Influenza Planning Checklist
References
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Re: Home Care of Flu Patients

Post by Readymom »

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The flu - Caring for someone sick at home
https://www.cdc.gov/flu/pdf/freeresources/general/influenza_flu_homecare_guide.pdf

Will you know what to do if someone in your house gets the flu?
Read this booklet to learn how to care for someone with influenza (the flu).

Includes:
  • About the flu
    Flu germs are spread from person to person
    The flu may be more serious for some
    Know the signs and symptoms of flu
    Make a separate sick room, if you can
    Tips to prevent fluid loss (dehydration)
    Medicine safety
    About fever
    About coughs
    Treat other flu symptoms
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Re: x-Home Care of Flu Patients-How To

Post by Readymom »

Good Home Treatment of Influenza - Dr Woodson
https://www.westerncape.gov.za/other/2009/8/flu_home_treatment.pdf

A practical guide to home care of mild to severely ill patients that relies on a simple common sense approach

In the event of a bad flu epidemic or even a modest pandemic the healthcare systems everywhere will become quickly overwhelmed. I discuss the reasons why below but suffice it to say that this little booklet is one of those essential items that when not if that occurs you will need desperately at some time in the future. No one can predict when. The information contained within it will remain current I assure you because it does not rely on prescription medications etc. The elegance of this booklet is that it relies on mainly pre-20h century tech from a post-20thcentury knowledge base. I trust you will have had the foresight to download it and print several copies now while the power grid functions and store them safely. ---CONTINUED---
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Re: x-Home Care of Flu Patients-How To

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Stay At Home Toolkit for Influenza
http://www.cidrap.umn.edu/sites/default/files/public/php/234/234_toolkit_0.pdf

Montgomery County Department of Health and Human Services, Public Health Services - Montgomery County Maryland

Includes:

Section I-Prevention

• Preventing the Spread of Influenza
• Cover Your Cough
• Maintain a Healthy Mind and Body
• How to Use a Thermometer
• Formula for Disinfection
• Influenza Stay At Home Toolkits

Section II-Caregiving: Care for Families, Friends, Neighbors and Pets

• How to Care for Someone with Influenza
• Personal Care Log
• Disaster Preparedness Animal Supplies Checklist
• Guidance for Employees Returning Back to Work after Influenza Illness
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