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Office h1n1 triage questionnaire

Are you concerned that you or a family member might be sick with H1N1 flu?
Follow this set of questions and find out what to do.
Question #1:
Does the patient have a new cough, or new shortness of breath (not related to feeling anxious)?

No… be reassured, they do not have H1N1. Stop right here.
Yes… Continue with questionnaire.
Note: sore throat or runny nose, without cough and fever, are not signs of H1N1.
Question #2:
Have you taken the patient’s temperature when he/she is hot, shivering, or sweaty?
The temperature is an important tool to help tell who might have H1N1 flu and who does not.

Obtain a digital thermometer at your local pharmacy or department store.
If temperature is less than 38oC or 100oF: They do not have H1N1. Stop right here.
Do this questionnaire again if fever develops (38oC or 100oF or greater)
If temperature is 38oC or 100oF or greater, Continue with this questionnaire.
Question #3:
Does the patient have any of these? If yes, they should go to Emergency Dept right away.

unconscious, confused, or having seizures (fits, epilepsy) breathing fast or gasping, either at rest or with minimal activity blue lips or skin unable to drink or keep down fluids stiff neck new rash especially if purplish
Question #4:
Does the patient have any of these? If yes, see your doctor or walk-in clinic, but not Emergency
Dept.

Fever lasting more than 4 days Asthma, emphysema, COPD, or other chronic lung disease Cerebral palsy or other severe physically disabling neurologic condition Immune deficiency, or now taking medications that depress the immune system (for example: prednisone, methotrexate, Imuran, Embrel, Remicade, Humira, Orencia, CellCept, Protopic, cancer chemotherapy, radiation therapy) Under age 5 years Pregnant Heart Failure Liver failure Poorly controlled or longstanding diabetes On dialysis or near to starting it Question #5:
Does the patient seem to look like the following?
If yes, they should stay at home, they don’t need to see a doctor, and they can treat themselves in
the comfort of their own home (see instructions below).

Fever no longer than 4 days May have extreme fatigue, probably wants to stay in bed Coughing but no trouble catching breath at rest, except when coughing May have little or no appetite but able to keep fluids down May have mild to moderate diarrhea May have lots of muscle aches and pains May have headache but not confused Over age 5 years Not pregnant Instructions for self-treatment of H1N1 flu at home:
Adults: Acetaminophen [Tylenol] Regular tabs (325 mg), 1 or 2 tablets every 4 to 6 hours for fever and pain. Avoid the extra-strength (500mg) tablets because they can lead to liver damage if two tablets are taken every 4 hours for more than one day. Children: Acetaminophen [Tylenol, Tempra] according to the dose on the box Do not take aspirin [ASA], ibuprofen, naproxen or similar medications [Advil, Motrin, Do not take cough syrups or oral decongestants because they don’t work and may lead to Do not take antibiotics leftover in your cupboard from a previous illness Stay at home (no work, shopping, recreation, worshipping) until a full day free of fever Health-care personnel are required to stay off work for 7 days from date symptoms started If symptoms worsen or fever lasts longer than 4 days, do this questionnaire again, and then visit your doctor, a walk-in clinic, or Emergency Dept (as directed by the questionnaire) Self treatment does not usually include Tamiflu; that medication is only for certain H1N1 cases and needs a doctor’s prescription You do not need to be tested for H1N1. Testing will not help you and the labs have been instructed only to accept samples from patients sick enough to be admitted to hospital. Women with H1N1 flu in the second half of pregnancy may benefit from early use of Tamiflu (within 36 to 48 hours of start of symptoms); they need to contact their doctor as soon as they feel sick. Asthmatics with H1N1 flu may benefit from early use of Tamiflu (within 36 to 48 hours of start of symptoms); they need to contact their doctor as soon as they feel sick. Created by R.A.Pennie MD, FRCPC, Infectious Specialist Brant Community Healthcare System October 20, 2009

Source: http://img194.imageshack.us/img194/7637/h1n1questionnaire.pdf

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