Acute hypoxic respiratory failure secondary
Influenza infection

  • CC: Fever, cough, shortness of breath, weaknes

  • PP: Fever/chills, myalgias, fatigue, cough, dyspnea, hypoxia, decreased PO intake, sore throat, headache

  • PN: No hemoptysis, no unilateral leg swelling, no severe chest pain

  • Pertinent SHx: Tobacco/vaping, EtOH use, drug use, sick contacts, vaccination status, nursing home exposure

  • Etiology: Influenza viral infection causing viral pneumonia, hypoxic respiratory failure, COPD/asthma exacerbation, or secondary bacterial pneumonia

  • Risk Factors: Elderly age, COPD/asthma, CHF, CAD, diabetes, CKD, obesity, immunosuppression, smoking

  • Initial DATA: CBC, CMP, procalcitonin, lactate if septic, flu testing, CXR, VBG/ABG if hypoxic, EKG, pulse ox

  • Pending DATA: Blood cultures, sputum cultures, MRSA nares, respiratory cultures

  • MEDS: Oxygen PRN, oseltamivir, antipyretics, bronchodilators PRN, empiric antibiotics if bacterial superinfection suspected, DVT prophylaxis

  • COURSE: Presented with influenza symptoms and hypoxia requiring inpatient admission for oxygen support, monitoring, and treatment.

Plan

  • Monitor respiratory status and oxygen requirement

  • Wean O2 as tolerated

  • Continue Oseltamivir (Tamiflu) Most benefit (if sx started <48 hrs) 75 mg PO BID for 5 days (Renal adjustment CrCl 30–60 → 30 mg BID CrCl <30 → 30 mg daily)

  • Supportive care/hydration

  • Pulmonary hygiene/incentive spirometry

  • Monitor labs and fever curve

  • Evaluate for secondary bacterial pneumonia

  • DVT prophylaxis

  • Isolation precautions

  • Escalate respiratory support if worsening hypoxia