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Posted: January 15 2006 at 12:33pm

Wilco on that Sophia, correction noted, page edited.
As my daughter might say, "you da bomb!" LOL!
Thanks Sweetie!

MK

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http://www.blackwell-synergy.com/links/doi/10.1046/j.1442-20 0x.2000.01204.x

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Posted: January 15 2006 at 12:50pm

An interesting counter your (generally accepted best advice) of maintaining a moderately elevated temperature in fighting infection.

This might indicate that a modest state of HYPOTHERMIA may be beneficial in allowing the body time to control infection with regards to cytokine storm.

Hypothetical pathophysiology of acute encephalopathy and encephalitis related to influenza virus infection and hypothermia therapy

Shumpei Yokota, Tomoyuki Imagawa, Takako Miyamae, Shu-Ichi Ito, Shoko Nakajima, Atsuo Nezu and Masaaki Mori

AbstractBackground: To establish a treatment strategy for acute encephalopathy and encephalitis associated with influenza virus infection, the pathophysiology of the disease was investigated through manifestations and laboratory findings of patients.

Patients and Methods: A child with central nervous system (CNS) complications during the course of influenza virus infection was analyzed in view of immunologic abnormalities. In addition, four children with acute encephalopathy and encephalitis were enrolled in the hypothermia treatment for the purpose of stabilizing the cytokine storm in the CNS.

Results: The CNS symptoms preceded the systemic progression to the failure of multiple organs (MOF) and disseminated intravascular coagulopathy (DIC). The mild hypothermia suppressed the brain edema on computed tomography (CT) scanning and protected the brain from the subsequent irreversible neural cell damage.

Conclusion: The replicated viruses at the nasopharyngeal epithelium may disrupt the olfactory mucosa and gain access to the brain via the olfactory nerve system. The direct virus�glial cell interaction or viral stimulation of the glial cells induces the production and accumulation of the pro-inflammatory cytokines, especially tumor necrosis factor (TNF)-�, in the CNS. The cytokine storm results in neural cell damage as well as the apoptosis of astrocytes, due to the TNF-�induced mitochondrial respiratory failure. The disruption of the blood�brain barrier progresses to the systemic cytokine storm, resulting in DIC and MOF. Mild hypothermia appears promising in stabilizing the immune activation and the brain edema to protect the brain from ongoing functional, apoptotic neural and glial damage and the systemic expansion of the cytokine storm.

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http://www.medicinenet.com/script/main/art.asp?articlekey=55 115
http://www.medicalnewstoday.com/medicalnews.php?newsid=32943

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Posted: January 15 2006 at 1:43pm

SophiaZoe,

Based on your concern about Gatorade, I decided to do my homework (shame on me, I know, should have done that before buying it) and happily I have the following studies to cite:

According to these, Gatorade does appear to be an acceptable improvised solution to dehydration as compared to Pedialyte. The category in which it falls somewhat short is in potassium repletion. I may have to pick up some saltpeter or salt substitute (usually Potasium Nitrate KNO3) to put a pinch into the Gatorade for a total solution. Bet it's still far cheaper than pedialyte, which I can't stand the taste of.

Best of all, I will enjoy the Gatorade this summer.

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Posted: January 15 2006 at 1:59pm

For the cost conscious out there...there are recipes on the net for homemade electrolyte replacements. I will also try to find the recipe in Where There Is No Doctor or perhaps Austere Medicine Can't get much cheaper than do it yourself and you will control the sugar amount to what's acceptable to you and your situation.

But if Gatoraide's sugar content isn't a detriment then it sure is a good alternative. Stores easy, not too expensive.

The following is from Dr Grattan Woodson's Preparing for the Coming Influenza Pandemic

Oral Rehydration Solution (ORS):

4 cups clean water

3 Tablespoons of sugar or honey

1/3 teaspoon table salt.

If dehydration is due to diarrhea you can substitute salt in the formula with 1/2 teaspoon of baking soda because diarrhea leads to loss of alkali. Do not increase amounts of salt or soda, already at maximum dose.

Edited by SophiaZoe

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Posted: January 15 2006 at 4:40pm

Sophia,

There are millions of medical articles written by both geniuses and quacks.

One would need to verify the scientific manner,repeat said situation many times over with the same results, analyzing their data's accuracy, etc., before confidently making an intelligent decision whether or not to implement their ideas in a medical crisis situation.

I still stand with the conservative thinking of increased temp kills virus.

I believe this is God's perfect design, creating fever for a purpose, to destroy bacteria/virus.

I try to be careful what I put out there, I don't want to be responsible for leading someone down a dangerous road, that can prove fatal.

FRIENDS PLEASE CALL YOUR DOCTOR NOW AND ASK WHEN TO TAKE MEDS AND HOW MUCH/HOW OFTEN TO TAKE IT. : )

God bless,

Mary Kay RN

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Posted: January 15 2006 at 5:33pm

MaryKay, I am going to say something incredibly snotty here but sorry, I just can't help myself...

Yeah, tradition modern medicine is doing such a STELLAR job of treating H5N1 patients.

OK, my inner brat is put away now.

In all seriousness H5N1 is for all intents and purposes a novel illness that is challenging our modern theories of medicine and defeating the best minds of medicine. You do a wonderful thing by pointing out generally accepted, best available advise. It is a credit to you as a person and your profession.

But H5N1 is NOVEL and there is a credible case to be made that mild hypothermia needs to be explored as a modality of treatment. We will not have answers to these questions until if and when we have hundreds or perhaps thousands of cases to test best treatments.

I'm sorry, I know I must drive you nuts. But I believe in exploring treatment options. So I guess I'm just going to keep you busy countering my posts. Information exchange is why I'm here. You are a valuable part of that exchange.

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Posted: January 15 2006 at 7:38pm

Dear Snotty, : )
As viruses are constantly mutating and new strains develop, new vaccine blends are having to be designed. Tough job! The medical world is far from knowing it all, that's for certain, but they have made spectacular advancements that we all appreciate when we get sick.
All the answers, never.
But I do know that increased temperture destroys bacteria/virus.

OK Sophia, how about if we do this? You treat your family members with hypothermia and I'll treat mine with hyperthermia, then we can tell everyone who's family members are still alive? Sound good?

After having read the article, I contacted the scientist
in Japan. Hopefully he will honor my request and reply to this forum.

Parting thought:

"I am fearfully and wonderfully made and my soul knows it very well."
God designed it.........I'll trust in Him.

Mary Kay RN

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Posted: January 15 2006 at 7:56pm

I hate to go back to the subject of nasogastric tube for aiding severe
dehydration, but here I am.

There was quite a discussion about this and I don't know that the proper
technique for us laypeople ever was decided, Is this correct?

I also have a question about attempting to aid breathing thorugh the use
a hand-held respirator (astro bag?) and that this just might give the
patient enough help to see them through.

I assumed this device was somehow held in place with a tube going into
the mouth and perhaps just a little way down the throat. Second hand
info from a physician seemed to indicate that this bag called for
untubation into the lungs. Arghhh. Please clarify, those who know!
Thanks. Rocky

Prepare for the Unexpected!
Rockyhttp://www.homeemergencyusa.com

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Posted: January 15 2006 at 8:08pm

MaryKay, thanks for thinking about contacting to scientist!

Ill family members...well that was inviting some pretty heavy karma there MK.

Rocky,

NG tubing...I did the Google thing...I printed the instructions, have the stuff. HOPE I never have to use it. I will differ to MaryKay for guiding you on the procedure. Please re-read her description and look around the net, there are some decent diagrams, etc.

RE: Bag-valve mask (Ambu-bag)...Also in my pile of "stuff", I will wait to see if any of the medically informed will weigh in. I have been duley slapped on the wrist once already today. . If no-one responds after a reasonable delay I will jump my layman's audacious butt once more into the breach ready to field any and all sanctions for stepping over the line

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Posted: January 16 2006 at 12:36am

This is my first post on this board, Please be gentle.

An ambu-bag (don't leave home without out one), can be used to assist ventilation. I've kept one in my personal first aid kit for 25 years, and it has come in handy.

It does, however, require someone to operate it. A patient might be kept alive through a respiratory crisis using one, but this could become a long siege. Still, if the manpower is available, I would be tempted to use one. This technique has been used in ICU's when the ventilators malfunctioned or the power goes out.

There are perils, however. Without an intubation tube, there is a good chance that with prolonged application, air will be delivered to the stomach as well as the lungs. This can result in the patient vomiting and aspirating the stomach contents into the lungs.

There are generally three ways to provide an `airway' to the lungs when using an ambu-bag. The best is an endotrachial tube, but inserting one is a skill that a lay person is unlikely to aquire. Second best is an esophageal obturator, which is easier to insert, but still requires training. Both of these can prevent inflating the stomach and subsequent aspiration.

The third type is a simple oropharengeal airway. A curved plastic tube that slips into the mouth and over the tongue. It's quick, easy, and can improve the delivery of air to the paitent. It, however, does not isolate the stomach, and therefore does not prevent aspiration.

This type of airway is the one the lay person is most likely to have access to, and have the ability to use.

You should also be aware that starting this sort of assisted ventilation is easy. The decision to discontinue it is not. There may come a point in time where the manpower is unavailable, or the patient's condition continues to deteriorate, where that decision must be made. It is never easy to `call' a code and discontinue life saving efforts. To do so to someone in your family would be much tougher.

That said, I would personally opt to use one if I felt the patient had a chance of recovery. I would, howver, be fully aware that this could be an exercise in futility.

Edited by Fla_Medic

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Posted: January 16 2006 at 2:24am

Fla Medic, welcome aboard, it will be wonderful to have your input here. You have touched on some great points.

IdahGirl

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Posted: January 16 2006 at 6:13am

Fla_Medic wrote:

This is my first post on this board, Please be gentle. ��

An ambu-bag (don't leave home without out one), can be used to assist ventilation.� I've kept one in my personal first aid kit for 25 years, and it has come in handy.It does, however, require someone to operate it.�� A patient might be kept� alive through a respiratory crisis using one, but this could become a long siege.� Still, if the manpower is available, I would be tempted to use one.� This technique has been used in ICU's when the ventilators malfunctioned or the power goes out.There are perils, however.� Without an intubation tube, there is a good chance that with prolonged application, air will be delivered to the stomach as well as the lungs.� This can result in the patient vomiting and aspirating the stomach contents into the lungs.� There are generally three ways to provide an `airway' to the lungs when using an ambu-bag. The best is an endotrachial tube, but inserting one is a skill that a lay person is unlikely to aquire.� Second best is an esophageal obturator, which is easier to insert, but still requires training.� Both of these can prevent inflating the stomach and subsequent aspiration.The third type is a simple oropharengeal airway.� A curved plastic tube that slips into the mouth and over the tongue.� It's quick, easy, and can improve the delivery of air to the paitent. It, however, does not isolate the stomach, and therefore does not prevent aspiration.This type of airway is the one the lay person is most likely to have access to, and have the ability to use.� You should also be aware that starting this sort of assisted ventilation is easy.� The decision to discontinue it is not.� There may come a point in time where the manpower is unavailable, or the patient's condition continues to deteriorate, where that decision must be made.� It is never easy to `call' a code and discontinue life saving efforts.� To do so to someone in your family would be much tougher.That said, I would personally opt to use one if I felt the patient had a chance of recovery.� I would, howver, be fully aware that this could be an exercise in futility.�

You forgot the masks in your 3rd option (proper fitting ones) and you have to know how to hold them (pretty strenious to do that correct, you will end that after half an hour because you cannot hold it any longer - unless you start training your hands).
If you do not ventilate, your third option (without mask) is a good way to ease breathing in a semiconcious patient and it is not associatet with to much risk if done incorrectly, hard to do anything wrong with that.
The esophageal obturator does not completely prevent aspiration.
With 2nd and specially third option you are inflating the stomach sooner (mask) or much later so everything is fine in a resucitation situation but 2nd is only goood for some time and third you can manage an hour and then either you or your patient really runs into a big problem.
Long term ventilation (more than one or two hours) you will not be able to do without intubation - well there is one more possibility and I am sure that will also come up. Since I do not believe that any of this techniques will do any good if not well applied, I will not bring it up, some of the internet-paramedics will dig it out sooner or later.

If you really want to use tools like that, take training courses and practise on your pets, not your "most beloved".

Individual preparation is mandatory

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Posted: January 16 2006 at 7:52am

Concerned brought up some points I'd like to address.

First, it should be noted that if the time comes where a flu victim is in such respiratory distress that assisted ventilation is needed, and you are dealing with the patient in a non-hospital environment, the prospects are grim. The fluid load in the lungs will likely override any benifits of assisted ventilation.

Scenarios where it might make sense are when a patient has been given an anti-viral, such as Tamiflu, and you are waiting to see if the patient will respond, or if there is the intent of moving a patient to a medical facility where a ventilator might be aquired.

Using an ambu-bag is, indeed, a bit of an art, particularly when no endotracheal tube is inserted. Proper mask fit is imperative. It may look easy, but as concerned pointed out, it can soon become exhausting. Ideally, if this were to be attempted, you'd have to have more than one person able to provide this assistance, and they would trade off every 20 minutes.

The esophageal obturator is not perfect, but it is a step above an oropharengeal airway. At about 50 bucks apiece, I doubt many will include it in their medical kit. It does require training to insert. You need to be able to insert it, and determine that you have inserted it correctly, else you run the risk of putting it down the trachea, cutting off all air to the lungs.

I think the point here is, that if a patient is not able to breathe on their own, they are going to die. While attempting to assist ventilation may not be ultimately sucessful, at least it has a shot. Doing nothing does not. This is a last ditch, desperation move. You have to decide whether trying, and probably failing, is better than not trying at all.

Concerned has made an excellent point, and I will second it. It is not too late to take an EMT or other medical training course. Many junior colleges offer this as a night class.

While I doubt that assisting ventilation under these conditions will result in a favorable outcome, if it were a member of my family, and I had reason to believe that buying a few more hours might make a difference, I would certainly try.

The grim facts are that without an endotracheal tube, the patient will likely aspirate at some point. Or the fluid buildup in the lungs will become so great that even with the ambu-bag you will not get enough 02 perfusion to make a difference. We are talking heroic measures here, with a very low probability of success.

It's never easy to let a patient go, to let nature take its course. Sometimes tho, it's the right thing to do. If H5N1 becomes a high path H2H infection, some patients are simply not going to make it. Adults should make their wishes known to those around them regarding heroic measures. Living wills should be made out in advance.

And as a caregiver, you need to steel yourself for the possibility that no matter what you do, no matter how hard you try, you may not get the outcome you were looking for.

Edited by Fla_Medic

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Posted: January 16 2006 at 10:08am

Concerned, thanks for all of your input here, it is appreciated. I was wondering If you could add your thoughts to the thread on pneumonia vac's. Pretty please!

Thanks, IdahGirl

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Posted: January 16 2006 at 11:09am

Fla_Medic wrote:

Concerned brought up some points I'd like to address.First, it should be noted that if the time comes where a flu victim is in such respiratory distress that assisted ventilation is needed, and you are dealing with the patient in a non-hospital environment, the prospects are grim.� The fluid load in the lungs will likely override any benifits of assisted ventilation.Scenarios where it <span style="font-style: italic;">might </span>make sense are when a patient has been given an anti-viral, such as Tamiflu, and you are waiting to see if the patient will respond, or if there is the intent of moving a patient to a medical facility where a ventilator might be aquired.� Using an ambu-bag is, indeed, a bit of an art, particularly when no endotracheal tube is inserted.� Proper mask fit is imperative.� It may look easy, but as concerned pointed out, it can soon become exhausting.� Ideally, if this were to be attempted, you'd have to have more than one person able to provide this assistance, and they would trade off every 20 minutes.The esophageal obturator is not perfect, but it is a step above an oropharengeal airway.� At about 50 bucks apiece, I doubt many will include it in their medical kit.� It does require training to insert. You need to be able to insert it, and determine that you have inserted it correctly, else you run the risk of putting it down the trachea, cutting off all air to the lungs.I think the point here is, that if a patient is not able to breathe on their own, they are going to die.� While attempting to assist ventilation may not be ultimately sucessful, at least it has a shot.� Doing nothing does not.� This is a last ditch, desperation move.� You have to decide whether trying, and probably failing, is better than not trying at all.Concerned has made an excellent point, and I will second it.� It is not too late to take an EMT or other medical training course.� Many junior colleges offer this as a night class.� While I doubt that assisting ventilation under these conditions will result in a favorable outcome, if it were a member of my family, and I had reason to believe that buying a few more hours <span style="font-style: italic;">might</span> make a difference, I would certainly try.The grim facts are that without an endotracheal tube, the patient will likely aspirate at some point. Or the fluid buildup in the lungs will become so great that even with the ambu-bag you will not get enough 02 perfusion to make a difference.� We are talking heroic measures here, with a very low probability of success.� It's never easy to let a patient go, to let nature take its course.� Sometimes tho, it's the right thing to do.� If H5N1 becomes a high path H2H infection, some patients are simply not going to make it.� Adults should make their wishes known to those around them regarding heroic measures.� Living wills should be made out in advance.� And as a caregiver, you need to steel yourself for the possibility that no matter what you do, no matter how hard you try, you may not get the outcome you were looking for.�

Great post. Have to quote it in full lenght...
You expresed what I did not dare to (and pretty eloquent and to the point).
Fortunately there is time for those "concerned" to get training. Even if they never use it for a pandemic situation, its usefull in general live for much more likely scenarios.

Individual preparation is mandatory

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Posted: January 16 2006 at 11:13am

IdahoGirl wrote:

<TABLE id=HB_Mail_Container height="100%" cellSpacing=0 cellPadding=0 width="100%" border=0 UNABLE="on">
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Concerned, thanks for all of your input here, it is appreciated. I was wondering If you could add your thoughts to the thread on pneumonia vac's. Pretty please!

Thanks, IdahGirl

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you better ask fla medic, he/she explains everthing very well and sound.
I do not have to add anything other than that a pneumonia vac is a good idea but I will have a look at that thread

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Posted: January 16 2006 at 2:28pm

Thank you for your kind words, Concerned.

There are areas where I have experience and expertise, and I am happy to provide my `opinion'. Questions regarding triage, extrication, `field medicine', and basic life support, I feel comfortable addressing.

There are other areas where I may have some knowledge, but as it is not firsthand, I would decline to opine. The Pneumovax is one of those subjects. At best, all I would be doing is parroting something I heard somewhere.

I'd prefer to leave the `hardcore' medical questions to those more qualified to answer them.

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Posted: January 22 2006 at 6:43pm

Mary Kay wrote:

All the answers, never.
But I do know that increased temperture destroys bacteria/virus.

OK Sophia, how about if we do this? You treat your family members with hypothermia and I'll treat mine with hyperthermia, then we can tell everyone who's family members are still alive? Sound good?

After having read the article, I contacted the scientist
in Japan. Hopefully he will honor my request and reply to this forum.

Mary Kay,

It's been a week. Has that scientist contacted you yet? I appreciate that you are an RN and look forward to your informative posts.

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Posted: January 23 2006 at 11:12pm

The scientist was asked to comment on the use of hypothermia on bird flu's fever. I have no idea what he will do.

Let me encourage you to read "The Great Influenza" by John M. Barry and then you can better decide what plan of action to take, OR you can just call your doctor, and trust in his/her advice.

MK

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Posted: February 03 2006 at 8:21pm

OTC meds, etc.

Hello. I'm a newbie. Wow this site is really great.

1. I found a helpful web site link (below) which had a hand book which deals with types of meds, care, etc. It's in simple terms. Of course I am not a MD so I read it critically and I still found it helpful. I do not think it is not comprehensive for my needs but a good start .

2, The book: "Where there is no doctor" by David Werner is also a basic level medical guide, FYI.

3. Does anyone have a way to make a home bed room a negative airflow room. I've got some ideas but woefully incomplete. I am praying nothing happens but in my universe of experiences, it's better to be ready. -KJ

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Posted: February 03 2006 at 8:35pm

Stormriderfla,

Thanks for the link. I saved it and will read every word. Great information.

Welcome my friend!

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Posted: February 06 2006 at 9:41pm

Some posts back it was mentioned that keeping a person upright aids in breathing, it does but -- your letting the secretions stay in the lungs by gravity. Postural drainage helps in clearing the lungs. This should be done after taking a tussin product [which thins secretions]

Any thoughts on percussion, since there is bleeding in the lungs would this be contraindacated?

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Posted: February 06 2006 at 10:25pm

Chest percussion therapy and postural drainage would apply IF the patient had thick tenacious mucus, but not so in this case.

The lung's alveoli are bursting, with bleeding causing suffocation.

Keep patient in an upright position for maximum lung capacity.

Mary Kay RN

Edited by Mary Kay

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Posted: February 07 2006 at 12:38am

Mary I can understand that percussion would agravate the bleeding. But it is my understanding that with the cytokine storm alot of debri is left causing copoius amts of thick secretions. Am I wrong?

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