Colorized transmission electron micrograph of Avian influenza A H5N1 viruses (seen in gold). Image provided by CDC/C. Goldsmith, J. Katz, and S. Zaki.
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Advanced Home Treatment
During the pandemic, there may be times when access to conventional medical
resources will be limited or not available. Medical professionals may find
themselves at home helping their neighbors take care of sick family members and
friends that would ordinarily be treated as hospital inpatients. Providing
care under these less than ideal circumstances will be very challenging. What
I wanted to place here were resources that would provide guidance to health
professionals providing care for people away from the conventional setting.
With the exception of the one item on Survival and Austere Medicine, I was not
able to accomplish this. The prevailing opinion seems to be that doctors and
nurses will be practicing medicine in the same way during the pandemic that
they did prior to it. This seems highly doubtful. Nevertheless, I have placed
a couple of items for you to review here. I have graded each for their
potential usefulness under pandemic conditions as I see them playing out. I
will continue to look for additional materials and if need be, might even write
down a few ideas of my own on this.
Grattan Woodson, MD, FACP
-- Added 01/11/07 --
-- Added 12/10/06 --
- Emergency NG and Rectal Rehydration in the Home Setting
(96.03 k)- Home Pandemic Preparedness for Medical Personnel
- (44.18 k)
- Salt and water absorption by the colon GUT 1998
- (204.8 k)
-- Previous Entries --
- Influenza Report 2006.pdf
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Influenza Report provides a comprehensive overview of human and avian influenza. It is a free online textbook on flu that is authored by several experts in their respective fields. The book has chapters on virology, drug treatment of flu, flu immunology, and lab diagnosis. There is information about vaccines and the problems with the current methods of producing them for flu. Overall, this is a good reference but too academic to provide much practical help to the doctor or nurse trying to resuscitate a dehydrated teenager or treat a 6 months pregnant 31 y/o mother of 2 hypoxic with pneumonia, both at home. B+
(2.7 mb)
- Treatment of Avian Flu WHO May2006.pdf
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This paper represents a panel opinion on treatment of H5N1 should it become
pandemic. The focus is on drug therapy with a focus on Tamiflu and
Relenza. Since some strains of H5N1 are amantadine sensitive, the panel
makes the surprising recommendation to for clinicians to consider using
combination therapy with a one of the neuraminidase inhibitors. They don’t
answer the important question of whether a higher dose and longer course of
oseltamivir is needed or even should be tried for treatment. They fail to
even mention the potential benefit of combining oseltamivir with probenecid
to increase the neuraminidase inhibitor’s plasma level and half-life. There
is no guidance on treatment of flu outside the high-tech environment. This
is a rather disappointing paper because of its lack of clear guidance and
absence of any suggestions for anything but treatments available only in
the high-tech hospital environment. D+
(1.19 mb)
- Survival and Austere Medicine: An Introduction Apr2005.pdf
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This resource is an excellent guide to the treatment of a wide range of
medical emergencies that might occur to people during times of crisis when
access to a conventional medical facility was not available. This book
should be downloaded and printed out. In fact, make two copies of it in
case your first one gets too foul to use or you need to give it to someone
else taking care of people in another location. The book could be used to
set up a clinic in a remote area where you would have a lab and some
technology. They have sections on treatment of NBC (nuclear, biological,
and chemical) injuries. These aren’t going to be useful for pandemic
medicine really. The sections on suturing, the psychology of being cooped
up, emergency dentistry, and anesthesia are really valuable. Also, they
have some great suggestions for other books that should be considered for
medical professionals tasked with providing care outside of the
conventional setting. A-
(3.9 mb)
- Treatment and Prevention of Flu: Swedish Consensus Group Recommendations 2003.pdf
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This 2003 publication in the Scandinavian Journal of Infectious Disease is
a conventional treatment and prevention guide. It discussed use of the
neuraminidase inhibitors for treatment of flu and vaccination and
neuraminidase prophylaxis for prevention. This document is a good review
appropriate for management of seasonal flu but has little to say about
pandemic influenza or its treatment either conventionally or
non-conventionally. C+
(182.31 k)