As doctors/nurses/paramedics/RTs, we sometimes feel immune to the same ills and injuries that befall our very patients. Sometimes nature reminds us that we are not.
Everyone remember the 2009 Swine Flu Pandemic?
Here is why.
The pandemic had started a few weeks prior. It had gripped my region with multiple cases reported in remote communities and causing one community to go into enforced quarantine.
The vaccine was still several months away. We were using Tamiflu fairly liberally as advised by public health department to try to minimise spread of the flu and treat high risk patient groups.
Initially during the containment phase of the pandemic, we were told to not fly/transport any suspected flu cases to avoid spread of illness. That quickly changed as it became pretty evident to front line staff that we were beyond containment of this pandemic. Critically ill septic flu patients were turning up..everywhere. And as we know now, many needed to get to an ICU , usually with ECMO to survive.
So there I was, out in a remote clinic , having finished a morning of general practice consulting and had some lunch. On return for the afternoon session, the clinic nurse steers me into the small treatment bay. I walked in and did not like what I saw.
There on the treatment bed lay an Australian Indigenous man, probably in his 40’s, very thin and semi conscious, breathing hard and fast. His family had found him at home and gave the story that he had been unwell with a fever and cough for about 3 days.
He had little medical history and rarely attended the clinic. I was told he tended to consume above average alcohol daily intake now for many years.
He looked like he was getting tired with his breathing and barely managed a grunt when I was examining him. He had a fever of 40C, HR 120, BP 70/50, SaO2 88% on 10 L/MinO2. There were coarse crackles in both lung fields. The nurse and I felt he had acute flu and we donned our masks and gowns.
It was me and the nurse for the next hour till the retrieval aircraft arrived. That was the first thing I did : call for help!
I wanted to intubate him to secure his airway and control his ventilation/improve oxygenation but had no ventilator in the clinic! So my plan was to resuscitate him as much as possible short of intubation and ventilation and then when the retrieval gear arrived with the vent, go ahead and RSI him.
I managed to get IV access in his left external jugular vein and started giving him a saline fluid bolus. We gave him IV antibiotics and after 2 litres of saline his BP was a bit better at 80/60 but he still was not looking too great.
We had no noradrenaline, dopamine nor dobutamine. No phenylephrine. No metaraminol. But we had adrenaline! Now how to give it? We had no IV syringe pumps, only an old IV pump. Simplest idea I had was to put a 1mg adrenaline into 1 litre of saline and start it at 300mls/hr = 5mcg/min adrenaline infusion.
I managed to insert a 14 G PIV cannula into his right femoral vein and we gave the adrenaline infusion through that.
We then inserted a bladder catheter and no surprises he had little urine output.
Anyway the retrieval nurse and all our usual transport gear arrived so we setup for RSI.
This was straightforward ketamine and sux RSI and it went fine. It did cross my mind that during laryngoscopy I probably was going to get cross infected. But hey I thought I was fit enough to handle the flu, right?
We dropped him off in ICU and I went home, washed all my clothes, had a shower and prepared to fly out to another base the next day to do an orientation week with a new doctor.
I started TamiFlu treatment that night.
The next 2 days I seemed to be ok. I remember that after 2 days I ran out of Tamiflu for some reason I forget. I did not think to get any more as I felt well.
The following day after I had run out of Tamiflu I started to develop a fever and runny nose. It progressed to a hacking productive cough, headache and rigors. I thought I would be ok. I was wrong.
48 hrs later I was dizzy on standing , continually coughing and feverish. I managed to start oral antibiotics and find some more Tamiflu. I felt awful. The sickest I had been in years.
Luckily after 24 hrs of oral antibiotics and Tamiflu I started to feel better and fever resolved.
I recovered and counted myself lucky. The patient who gave it to me was not so lucky.
I was the first one to line up to have the first dose of H1N1 vaccine when it was available!
Talking to colleagues I know some dont agree that annual flu vaccination is a reasonable choice for them. But I dont ever want to be that sick again if I can reasonably prevent it!