Wednesday, August 12, 2009

Practical Care for person suffering from Swine Flu

This was posted in our forum by and emergency health care person and I think it is good practical information. I'm posting it here and you can copy and print it out. I'll be adding to it later.
Mush much thanks to Fishsurfer!

Btw, id just throw this out real quick. Since Respiratory failure is the most common cause of death, if you find yourself isolated and caring for someone because all hell has broken loose, you need to make sure and remember a few things.

-Dont let the person your caring for lie in bed, it will only help fluids build up on the lungs.
-Do make them cough and/or use spirometer devices (the little thing with the ball you try and hold in the air inside a clear tube at the hospital), get the fluids out of the lungs..its feeding the bacteria.
-Make them get up and walk around, even if they hate you for it.
-Make them sit up in bed to sleep or rest as much as possible (everyone used to do that in the old days every night)
-Provide supportive care for their fevers, dont let it get out of control but dont let it go away imho (the higher temps can help fight the lung infection somewhat), its probably better to have a rough few days followed by shedding than weeks of continuous pounding that may seem minor but bites you in the ass.
-Provide "chest pt" by pounding on the back and front of chest for at least a few minutes a couple of times a day, followed by purposeful coughing. The pounding loosens up the crap, you cough it out. Hard enough to make them bounce a bit, but dont leave massive bruises or break ribs for christs sake.
-Fluids, give them enough to make their urine at least yellow if not clear.


I would also add to this, if the weather permits and it's still warm enouugh, put a window fan in the sick room window blowing out. This will pull virus outside away from other rooms in the house and help cut down on chances of others catching the flu.

Also, go ahead and wash in hot water with bleach, some bed sheets. Line dry them in the sun and fold and wrap them in plastic. A new fresh trashbag works good for this. Store these bed linens to use during illness.

More from Fishsurfer.

Famous quote describing Pneumonia by Hippocrates:

"Peripneumonia, and pleuritic affections, are to be thus observed: If the fever be acute, and if there be pains on either side, or in both, and if expiration be if cough be present, and the sputa expectorated be of a blond or livid color, or likewise thin, frothy, and florid, or having any other character different from the common... When pneumonia is at its height, the case is beyond remedy if he is not purged, and it is bad if he has dyspnoea, and urine that is thin and acrid, and if sweats come out about the neck and head, for such sweats are bad, as proceeding from the suffocation, rales, and the violence of the disease which is obtaining the upper hand"

Actually a pretty damn accurate account, very astute observations. And thats exactly what your going to need to make in a world without access to medical care or drugs, good observations. Prevention...of illness in itself or worsening of the condition...is the name of the game. The body can do an awful lot of things to fight illness, and it will keep at it for as long as your fed, hydrated, and motivated enough to keep on living.

Pneumonia in a non-medical environment is a very exhaustive and lengthy fight. It could easily go on for months. Some weeks may be difficult, others may be easier. Regardless, if H1N1 hits hard this fall or even this summer (unlikely), be prepared for a battle. Hospitals will be overrun, the economy will be in the process of collapse, social unrest is likely, you will rely on family or they may rely on you. There will be no ambulance coming to get you, the EMT's and Medics will be at home themselves.

In Pneumonia, the normal exchange of gases in the alveoli (air sacs) are interupted by the presence of fluid, mucous, etc... There are many types of it, and underlying conditions greatly affect the outcomes.

Three types: Bacterial, Viral, and Atypical Bacteria (walking pneumonia).

There are many other underlying types as well, although a bit more uncommon, fungi etc...

Risk Factors:

Age: 65 or older
Flu or other respiratory illness
Chronic illness, such as heart or lung disease
Stroke (aspiration pneumonia due to difficult swallowing)
Weakened immune system caused by AIDS or chemotherapy treatment
Chronic bronchitis
Malnutrition
Pregnancy
Infants and very young children
Alcohol or drug abuse
Smoking
Chronic exposure to certain chemicals (eg, work in construction or agriculture)


Fever
Shakes and Chills
Green Yellow Mucous or Rust colored
Profuse sweating (diaphoresis)
Bluish nail color, lips, due to lack of oxygen...(hypoxia)
Altered mental status (related to massive infection including sepsis, oxygen levels, organ failure, or all of the above.

You see how it starts out? Fever, then shakes and chills, etc... Dont let it get passed shakes and chills and your fine. If you start letting fluids and secretions accumulate in the lungs, you could be in real trouble.

The biggest problem with this condition is accumulating fluid and mucous in the lungs, which can even get into pleural spaces surrounding the lungs, called effusions; then a spiraling inffective respiratory exchange and potentially sepsis sum total.

One of my favorite methods besides deep breathing to get fluid and mucous out of the lungs is to do some Chest Physical Therapy. It has some contraindications however, if the person is so ill they are at the point of bronchospams, sudden constriction of the muscles in the walls of the airways bronchioles (the two little branches leading to your lungs); then its a bad idea to start doing this (you should have been doing it well before this stage) doing so now may cause spasms and increase their severity. Let them rest and fight it off a bit more, continue doing deep breathing though, you can always do that.

The important thing to note though is that if you do this as mentioned in the begining of the thread, make sure you cough afterwards. There is a right way to cough, sit up on a chair. Take a deep breathe for about two seconds and exhale for about two seconds. Then make two sharp coughs, rinse and repeat.


How do you know its happening, beyond the fever, H1N1 condition, etc...?

If you have a stethoscope, you can listen for diminished lung sounds in the lower bases of the lungs. Listen every few hours, and over time you'll notice the trend quickly. Of course, if you own a stethoscope, you probably already know this. So what if you dont? Well, you should get a cheap one even, for under 20 bucks you can easily get a model suitable for basic listening needs of the lungs (and heart somewhat). But if you still dont buy one, then you can use percussion techniques, although its highly not as reliable as actually listening with a scope.

To do that, you basically take two fingers placed together, and tap on the spaces around the lungs, basically at the base of the rib cage (although your lungs go all the way up to your clavicle region and then some. Tap on it, listen for the tones it makes. If your a musician, you may be able to recognize what a hollow sound is, and what a more solid (fluid filled) sound is. Tap on a wall, where there is no stud its a hollow sound, where there is a stud, is somewhat muted and diminished. Same with the lungs. Remember what the person your helping sounds like, write it down, track it for a few hours to days and even weeks or months. It could be your first indication something is happening, beyond the obvious fever and malaise that occurs with the Flu.

The kind of lung sounds you'll find in Pneumonia are loud low pitched bubbly gurgles, or high pitched low intensity sound that last beyond exhalation. You may also just hear diminished sounds in the begining. You can listen to them here:

http://mtsu32.mtsu.edu:11259/abnormal_breath_sounds.htm

Think of your lungs like a sponge. It has air exchange sacs all over it, trading away CO2 for Oxygen, grabbing Oxygen from air while discarding Nitrogen, CO2, etc... sending it to your Heart to be distributed through your bodies circulatory system before it comes back to the lungs. F'ng awesome interaction imho.

But, when liquids,mucous, and fluids settle on the base of the lungs, sides of the lungs, etc... it can create a cascade of interactions that eventually cause your condition to worsen, your fluids to increase, and your temperature to rise among many other things.

So, its important to move around, shift those fluids around a bit, shake the mucous around, let the unaffected portions of your lungs absorb some of the crap that has saturated the other part of your lungs because you were lying in bed for days. If you move around, sit up in bed often, and generally avoid a flat position thats unchanged, you can do a great deal to relieve your lungs and give yourself a fighting chance.

Equally important, if someone is so out of it, nearly delusional or non-compliant with your demands; at least rotate them in their bed. Much like they do at a nursing home for bed sores and other things, they also do it for patients with lung issues in an ICU or Pallative care facility. You can also do it when death is not imminent, and i would highly suggest it even when your healthy trying to recover without meds. Its always good to change positions, move around, change rooms your in (mental aid), or even take them outside for fresh air. Switch it up, keep them moving if possible. But recognize when someone just needs to rest. You dont want to over exert someone

The other thing to mention here is that with this strain of flu, the onset of symptoms and the time you have to use "Treatments" may be extremely extremely short.

You need a mercury thermometer. Old school bulb style. With a Flu strain, your fever will show up slowly over a day or two, if you take your temp twice a day at the very least during a Pandemic, you may catch the onset of illness before you actually would have noticed it. Get a thermometer!

Seriously though, treating Pneumonia is a bitch, you've got bacteria stuck inside your lungs, edema potentially occurring as a side effect, and no anti-biotics to treat the underlying causes of inflammation and fluid build up, the bacterial infection itself.

If you've got Pneumonia to the point your lungs are full of fluid, your in a world of hurt.

If you know of some good immune boosting treatments that are readily available outside of the hospital, then do it. If you have left over anti-biotics, give it a shot. Even if its meant for a dog, or an aquarium, whatever. Worst case scenario, humility and quality doesnt matter anymore. Something is probably going to be better than nothing. If its from the Amoxil family of drugs definately do take it.




I hope that this information is helpful. I'd like to thank Fishsurfer for the time he put into putting this information together for people to use.
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