Emergency guidelines for the management of patients with severe respiratory distress and shock in district hospitals in limited-resource settings

The preparation of these emergency guidelines for the management of severe acute illness, specifically respiratory distress and shock, in district hospitals in limited-resource settings has been prompted by an outbreak of pandemic influenza A (H1N1). Although most cases of pandemic influenza A (H1N1) (or other influenzas) are mild, a small proportion will develop severe, potentially fatal, complications. This is especially of concern in patients with co-morbidities such as chronic lung disease or diabetes mellitus, and extreme obesity, and in pregnant women. District hospitals and clinicians should be prepared to assess and treat patients with these severe complications when they occur.