79 year old female with stage 4 metastatic breast cancer and poor prognosis presented with progressively worsening shortness of breath. Chest XR revealed evidence of left-sided pneumonia with lung consolidation(click on image above). The patient requested a "full code" including intubation.

Yet another patient admitted with suspected H1N1. Very similar presentation this time as well. It starts as a flu-like illness and progresses to a full-blown ARDS (acute respiratory distress syndrome). The rapid flu test is negative again. I am not even sure if we should be using those. The patients are being treated empirically based on their presenting symptoms. It strikes me how quickly the patients develop organ failure including renal dysfunction. What looks like pneumonia on CXR is likely hemorrhagic pneumonia. That will explain why it’s so difficult to ventilate those patients. Most patients so far have some preexisting condition like diabetes, COPD, CHF etc.
We have been warned that there is national respirator shortage and we should use them sparingly. The vaccine is yet to be widely available.

I guess I was in a bit of denial about it. I was hoping that it would blow right past us until I realized that we are running out of ICU beds and somebody mentioned that we might need to borrow Nitric Oxide equipment. The presentation is quite similar so far. It starts as a flu-like illness with fever (up to 105), myalgias, sore throat etc. Several days later patients develop progressively worsening shortness of breath and cough. Once we see them in ER, they are already quite sick. The chest XR shows bilateral patchy infiltrates consistent with pneumonia. Surprisingly, the rapid swab test was positive in only a few of those patients. It appears that the sensitivity of this test is low. It takes several days to get confirmation on H1N1 from the State lab so the patients are being started on Tami flu empirically. Several patients have already progressed to a full-blown ARDS (click on image above) and multiple organ failure. I had to use high PEEP and FiO2 and yet oxygen saturation was barely in the 80’s. We had to use prone positioning and even Nitric Oxide. Sputum and blood cultures in most cases are coming back negative. The empiric antibiotics are being started to prevent secondary superinfection. Some patients require dialysis for kidney failure.
The H1N1 vaccine is being given to healthcare workers only sporadically so far (I got mine as soon as I could). Apparently, we might have a shortage of respirators and Tami flu. This is only October and I wonder how much worse this is going to get.