Dengue Fever Case Reporting

7/26/2019 Dengue Fever Case Reporting

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Good afternoon!

JI Balamban, Fabros, Pati


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THE CASE


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This is a case of a 2 ear old

female "ho came in d#e to

fe$er and abdominal %ain


4/101

&o histor of tra$el to other %ro$inces

&o "adin' in (ood "aters

Constant e)%os#re to rodents and li$esnear a (ooded area for the %astmonths*

+- .no"n cases of $ector relatedinfection in her ho#sehold, as hercommon la" %artner and child "eredia'nosed "ith the illness 2 ears a'o*


5/101

Patient "as a%%arentl "ell #ntil/


6/101

0 das PTA

Patient "o1e #% "ith#ndoc#mented fe$er

"ith associated sm%toms of s#dden onset headache, frontal

to tem%oral in location, throbbin'in character, non radiatin',

described as 345 in se$erit mal'ia and arthral'ia


7/101

0 das PTA

She too14* Phenle%hrine HCl Chlor%henamine

maleate Paracetamol +Bio(#- 55m'3 tab e$er 6 ho#rs for the fe$er

and headache2* Ib#%rofen Paracetamol

255m'372m' +Ala)an F8- formal'ia and arthral'ia

A9orded no relief


8/101

&o co#'hs, colds, chills, throat %ain,ear %ain, ear dischar'e, abdominal%ain, $omitin', diarrhea, ds#ria,hemat#ria, $a'inal dischar'e noted

&o cons#lt done


9/101

2 das PTA

Still "ith abo$e sm%toms no"di::iness ; s#dden onset of Abdominal%ain, b#rnin' in


10/101

2 das PTA

7 e%isodes of $omitin'of %re$io#sl in'ested food, non>bilio#s,

non>blood, "ater, and a%%ro)imatel

455 cc in $ol#me* Self>medicated Simethicone +.remil S- )

4 dose a9orded no relief of abdominal%ain

There "as no chan'e in bo"el mo$ement,melena, hematoche:ia, hematemesis

&o cons#lt done


11/101

4 da PTA

Fe$er s#bsided, b#t %ersistence ofabdominal %ain and headache noted"hich %ro'resses from =345 to 45345

Persistence of sm%toms %rom%ted

cons#lt


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Past ?edical Histor

S3P sal%in'o>oo%horectom, leftsecondar to ecto%ic %re'nanc+2540, PGH-

&o h%ertension

&o diabetes mellit#s

&o 1idne, li$er, or throid diseases

&o aller'ies to food or dr#'s &o %re$io#s PTB treatment


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FAMILY HISTORY

&o h%ertension, no @?,Bronchial asthma

&o 1idne, li$er, or throid

disease &o Cancer


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PERSONAL AND SOCIALHISTORY

Smo1er, %ac1 ears

ccasional alcoholic be$era'edrin1er

?ari#ana ) 4 #se +7 monthsa'o-

Ho#se"ife


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OB History

G2P4 4>5>4>4 4 li$in' child deli$ered $ia &S@

+??C,255-

S3P sal%in'o>oo%horectom, left,secondar to ecto%ic %re'nanc+2540, PGH-


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?enstr#al Histor

?enarche at = ears old A$era'e of 0 na%1ins a da,

soa1ed

&o histor of dsmenorrhea


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SEDA HIST8

Had 7 heterose)#al male %artner

First coit#s at 40 3o

C#rrentl ha$e 4 heterose)#al male%artner

&o histor of articial contrace%ti$e

method #se


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F#nctional Health Pattern

@iet 7 c#%s of rice3meal, $arieties of

meal

8e'#larl #ses condiments onfood salt, so sa#ce, sh sa#ce,%e%%er, s%ic %o"der

Fl#id inta1e 55ml of ater3da +2 c#%s-

7 bottles of Co1e

+o#nces3bottle- >


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F#nctional Health Pattern

Elimination Pattern rination )3da, li'ht ello"

and clear , +>- hemat#ria

@efecation 2)3da, 'olden bro"n,

+>- consti%ation +>- 'ross blood

Acti$it> E)ercise PatternSedentar lifestle


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REVIEW OF SYSTEMS

&o "ei'ht chan'es, no anore)ia

&o a#ndice

&o co#'hs, colds, ds%nea

&o chest %ain, no %al%itations, no ortho%nea,no P&@

&o ds#ria, oli'#ria, hemat#ria

&o diarrhea, consti%ation

&o %ol#ria, %ol%ha'ia, %old%sia, heatintolerance

&o calf tenderness ,rashes, ecchmosis,%#r%#ra, edema


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PHYSICAL EXAM


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GENERAL SURVEY

J*@* "as a"a1e, alert andcoherent and oriented to 7s%heres

Calm, no si'ns ofcardiores%irator distress

Amb#lator

Ectomor%hic


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VITAL SIGNST 7*0KC +a)illar-

P8 63?I& 88 4c%m

BP 4453L5 mmH' +sittin'-

ANTHROPOMETRIC

Hei'ht 4*0 meters

ei'ht061'

B?I 4=*7= +&ormal-


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SKIN

i'ht bro"n in color "ith s%arsehair, e$enl distrib#ted on alle)tremities

&o noticeable chan'e in s1in color &o rash, erthema, %#r%#ra,

ecchmosis

"arm to to#ch %in1ish nail beds

To#rni


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HEAD

&ormoce%halic atra#matic+&C3AT-

Hair "as nat#rall blac1 incolor M te)t#re is ne and "ithnormal hair distrib#tion

&o %al%able lesions, masses ortenderness


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EYES

&o %rotr#sions, retraction, droo%in'or edema in the eelids*

+>- lesions, masses and %eriorbitaledema and tenderness

Nis#al ac#it @ 25325 S 25325

$is#al elds intact

Sclerae "hite in color, +>- abrasions Pale and moist Pal%ebral

con#ncti$ae


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P#%ils e


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Bilateral 1idne>sha%e %inna

&o deformities, lesions, masses

Intact tm%anic membrane, cone of

li'ht %ointin' antero>inferiorl* &o %ain on t#'>test

+- "his%ered $oice hearin' test

8O

EARS


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&ose and nasal se%t#m midline

Patent nostrils

Frontal and ma)illar sin#ses non>tender

NOSE


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Pin1ish i%s

ith dental caries , incom%lete set ofteeth

Pin1ish b#ccal m#cosa and '#ms ,&obleedin'

&o #lcerations, in(ammation orbleedin'

&on>in(ammed Tonsils

Ton'#e and #$#la midline

THROAT


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&o asmmetries or masses

&on>%al%able throid 'land

&o nec1 $ein distention

&on %al%able cer$ical lm%h nodes

NECK


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&o deformities Smmetric chest e)%ansion "ith 'ood

l#n' e)c#rsion

&o $isible and %al%able masses

E


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Adnamic %recordi#m

&o thrills, lifts or hea$es

P?I thleft ICS ?C 4*diameter

Base S4 S2

A%e) S2 S4

S7 and S0 absent

&o m#rm#rs, no e)tra so#nds

HEART


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Breasts are e


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Sha%e 'lob#lar

In$erted #mbilic#s

Smmetrical, "ith $ertical s#r'ical

scar belo" the #mbilic#s,healed

&o dilated $eins

&o $isible %eristalsis or %#lsations

Bo"el so#nds normoacti$e +273min-

&o br#it, thrills

ABDOMEN


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Tm%anitic on all fo#r %al%able

&o CNA tenderness

ABDOMEN


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Arms and le's smmetrical, "arm,no edema

&o hematoma

Ca%illar rell 2sec #%%er andlo"er

Peri%heral %#lses smmetric arms

and le's +2 brachial, radial,%o%liteal and dorsalis %edis-

&o limitation 8?

EXTREMITIES


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Mus!" #u!$% smmetrical, 'oodtone both #%%er and lo"er

&o 'ross in$ol#ntar mo$ements

or atro%h Amb#lator, able to stand, slo"

stead 'ait

s#all sittin' #%%er bodleanin' for"ard

Mus!" str"&'t(% 03 #%%er, 3

lo"er

MUSCULOSKELETAL


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NEUROLOGIC EXAMINATION


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Level of Consciousness: Alert

Awareness:riented to %erson, %lace andtime

Behavior:Able to maintain 'ood ee contact,no mannerisms

Speech and language:?oderate rate, (#ent$oice, no hoarseness, dsarthria, able toa%%ro%riatel ans"er


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Object recognition:Can reco'ni:eobects seen3%al%ated +ball%en,noteboo1 and bottle of alcohol-

Aect:A%%ro%riate

P"r")tio&% Good tho#'ht %erce%tion !hought content:&o dist#rbed

tho#'hts*

MENTAL STATUS EXAMINATION


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CRANIAL

NERVE INTERPRETATION

I Able to smell coffee beans on both nostrils.

II

OD:20/20 OS: 20/20

Pupils are equally reactie to li!ht "#

2mm$ %ith &irect an&consensual li!ht refle'( ")$ accommo&ation

III

IV

VI

*'traocular muscle moements of both eyes are intact.

V

+orrectly i&entifie& the areas on the face %here li!ht brush stro,es

%ere applie& in.

+an close mouth an& !rin& teeth.

CRANIAL NERVE


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CRANIAL

NERVE INTERPRETATION

VII

-ilaterally symmetrical face

+an raise eyebro%s( %rin,le forehea&( close eyes ti!htly( an& puff

chee,s.VIII ntact !ross hearin!

IX

X

ntact !a! refle'

o hoarseness in oice

ula is in mi&line.

XIAble to shru! an& eleate shoul&ers( as %ell as rotate hea& a!ainst

resistance.

XII

1on!ue is in mi&line( not atrophie& an& can be moe& freely an&

from si&e to si&e. Patient %as able to stic, out ton!ue an& moe it

from left to ri!ht.

CRANIAL NERVE


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Smmetric m#scle b#l1 of %ro)imal anddistal m#scles of both #%%er and lo"ere)tremities*

&o atro%h of m#scles* &o clon#s, fascic#lations, sei:#res,tremors, and s%asm*

&o in$ol#ntar mo$ements

Arms and le's can be e)tendedthro#'ho#t the ran'e of mo$ement*

&o ri'idit, s%asticit, or (accidit*

MOTOR


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?#scle stren'th on #%%er and lo"ere)tremities are as follo"s

LUE *+* RUE *+*

LLE*+*

RLE *+*

MUSCLE STRENGTH


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Intact %ain, li'ht to#ch, s#%ercialsensation, dee% sensation and $ibratorsensation on both %lantar s#rfaces of feet,n'erti%s and both and e)tremities

mber identication, %oint locali:ation ande)tinction on both 8 and sides "ere intact

LUE,--.

RUE ,--.

LLE,--.

RLE ,--.

SENSORY


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REFLEXES RIGHT LEFT

-iceps )2 )2

1riceps )2 )2

-rachiora&ialis )2 )2

nee)2 )2

An,le )2 )2

REFLEXES


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Fin'er>to>nose test "as%erformed "ith slo" mo$ement

Able to "al1 across the room and

can rise from sittin' %osition "ithassistance

Good balance and 'ait

COORDINATION AND GAIT


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SALIENT FEATURES


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SALIENT FEATURES% PERTINENTPOSITIVE

23 F

ndoc#mented Fe$er for three das sis of fe$er on the fo#rth da

Headache +fronto>tem%oral,throbbin', 345-

?al'ia and arthral'ia


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Abdominal %ain +E%i'astric, B#rnin',45345, radiatin' to 8-

Persistent na#sea and $omitin' +),

in'ested food, non>bilo#s, no relief#%on inta1e of antacids-

oss of a%%etite

&o relief of sm%toms #%on inta1e ofmedications

SALIENT FEATURES% PERTINENTNEGATIVE


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&o histor of tra$el into %ro$inces

&o histor of "adin' into (ood"aters

&o %re$io#s renal, li$er disease

&o "ei'ht chan'es


S S


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&o rashes

&o chest %ain, ortho%nea, P&@

&o ds#ria, no oli'#ria, no hemat#ria

&o eas br#isalit


SALIENT FEATURES


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NS 4553L5=7 25 76*0=M B?I O4=* 1'3m2

Abdomen Flat, +- midline incision on

h%o'astri#m, h%o'astric area, 27 bo"el so#nds %er min#te,

i$er s%an 6 ) = cm, +- e%i'astric

tenderness #%on %erc#ssion and %al%ation +>- ?#r%hQs si'n, +>- 8o$sin' si'n, +>-

Psoas si'n, +>- bt#rator si'n

SALIENT FEATURES%PERTINENT POSITIVE FROM PE


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APPROACH TO DIAGNOSIS


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Fe$er

AbdominalPain

Ac#te

Infectio#s

@en'#eFe$er

e%tos%irosisT%hoid

Fe$er

&on>infectio#s

Gastrointestinal

A%%endicitis Cholecstitis Pancreatitis

Genito>#rinar

Pel$icIn(ammator

@isease

Chronic


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DIFFERENTIAL DIAGNOSIS


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Pel$ic In(ammator @isease

RULE IN

Fe$er

Abdominal %ain

RULE OUT

Absence of fo#l>

smellin' $a'inaldischar'e

+>- terine tenderness

@oes not #s#all

%resent "ith mal'iaand arthral'ia


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ACTE APPE&@ICITIS

RULE IN

Fe$er

oss of a%%etite

E%isodes of $omitin'

RULE OUT

+>- 8i'ht lo"er - 8o$sin' si'n +>- bt#rator si'n

+>- Psoas si'n


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ACTE CHECSTITIS

RULE IN

Female

Fe$er E%isodes of $omitin'

E%i'astric %ain+radiates to 8-

8 tenderness

RULE OUT

Pain is not 'enerali:edon the ri'ht #%%er

abdomen Pain does not radiateto the intersca%#lararea, ri'ht sca%#la, orsho#lder

@oes not %resent "ith?al'ia and arthral'ia

+>- ?#r%hQs si'n


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ACTE PA&C8EATITIS

RULE IN

Fe$er

Abdominal %ain

&a#sea and $omitin'

RULE OUT

&o radiation to the bac1

Absent abdominal

distention Absent m#scle ri'idit

Patient has normo>acti$e bo"el so#nds

?al'ia and arthral'ia +>- C#llenQs si'n

+>- T#rnerQs si'n


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EPTSPI8SIS

RULE IN

Fe$er

Abdominal %ain

&a#sea and $omitin'

?al'ia

RULE OUT

&o histor of "adin' into"aters

+>- a#ndice

&o ds#ria, no oli'#ria, nohemat#ria

Absent mac#lo%a%#larrash

Broncho$esic#lar breathso#nds

Pin1 %al%ebral con#ncti$a

+>- He%atos%lenome'al


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TPHI@ FENE8

RULE IN

Fe$er

Abdominal %ain Headache

?al'ia and arthral'ia

Anore)ia

&a#sea and $omitin' Abdominal tenderness

RULE OUT

&o histor of %rolon'edfe$er for #% to 0 "ee1s if#ntreated

Absence ofmac#lo%a%#lar rash +roses%ots-

&o chan'e in bo"el

mo$ement +>- He%atos%lenome'al

&ormal heart rate d#rin'time of fe$er


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@E&GE FENE8

RULE IN

Fe$er

Abdominal %ain

Headache

Persistent na#sea and

$omitin' ?al'ia and arthral'ia

RULE OUT

Cannot be r#led o#t


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APPROACH TO

DIAGNOSIS


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PATHOGENESIS

PATHOGENESIS


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A* ae'%ti

En$ironmental 8is1Factors3 Breedin' sites4* Sta'nant (ood

"ater2* Flo"er $ases3%ots7* Piles tires

PATHOGENESIS


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@E&GE PATHGE&ESIS

A* ae'%ti

E&/iro&0"&t1! Ris$F1tors+ Br""2i&'

sit"s4* Sta'nant (ood

"ater2* Flo"er $ases3%ots7* Piles tires

BITE OF A VIRUS 1rryi&'

0os3uitoSkin

BloodInfect cells

I&4"tio&I00u&" r"s)o&s"

Ati/1tio& T "!! r"s)o&s"50"0ory T "!! i4 r"6"7)osur"


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Ati/1tio& T "!!r"s)o&s" 50"0ory T "!!

i4 r"6"7)osur"

Sti0u!1t"s r"!"1s" o4yto$i&"s

P!1t"!"t s(i"!2s /irus4ro0 "7)osur" 1&2

#i&2i&'

N"utr1!i8" )r"6"7isti&'1&ti#o2y

P(1'oytosis

V1su!o)1t(y5P!1s01!"1$1'"9

Co1'u!o)1t(y5PTT+APTT9

T1r'"ts !i/"r 1&2s)!""& )1r"&(y01!

"!!s

HEPATOSPLENOME

GALY

Virus61&ti#o2y o0)!"7

AB "&(1&" u)t1$"

Cyto!ysis

Dir"t "!!u!1r 2"strutio&1&2 i&4"tio& o4 Bo&"

M1rro: )r"ursor "!!s ;s(ort"&"2 )!1t"!"t sur/i/1!

1usi&' )!1t"!"t !ys"s

THROMBOCYTOPENIA

DENGUE HEMORRHAGIC

High fever,body

weakness,headache anddizziness

Cyto$i&"s 2"stroy "!!0"0#r1&" 1&2 :1!! 5/ir1!

1&ti'"& i& 0o&oyt"9

Co0)!"0"&t syst"01ti/1tio&

V1su!1r "&2ot("!i1!

1ti/1tio&


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The In$esti'ation

aborator and @ia'nostic Proced#res


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THE INVESTIGATION%LABORATORY ANDDIAGNOSTICS


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< PHASES OF DENGUE


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asts 2>L das ?onitorin' for "arnin'

si'ns is cr#cial

?ild hemorrha'icmanifestations

Pro'ressi$e decrease inBC earliestabnormalit

To#rni


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@efer$escence on da 7C

Patient can either im%ro$e or deteriorate

e#1o%enia, thrombocto%enia, increase in Hct

,> D"&'u" :it(out :1r&i&' si'&s

?> D"&'u" :it( :1r&i&' si'&s

S"/"r" 2"&'u"

Clinical %roblems enco#ntered Shoc1 from the %lasma lea1a'e Se$ere hemorrha'e r'an im%airment

CRITICAL PHASE


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W1r&i&' si'&s% Increase in ca%illar

fra'ilit

Be'innin' of critical%hase

S"/"r" D"&'u"%4* Plasma lea1a'e and3or

(#id acc#m#lation

res%irator distress2* Se$ere bleedin'

7* Se$ere or'anim%airment

Clinical %roblems enco#ntered Shoc1 from the %lasma lea1a'e Se$ere hemorrha'e r'an im%airment

CRITICAL PHASE


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D"&'u" s(o$% critical $ol#me of %lasma is lost thro#'h

lea1a'e

Preceded b "arnin' si'nsTem% s#bnormal

Prolon'ed shoc1 or'an h%o%erf#sion

or'an im%airment, metabolic acidosis,@IC se$ere hemorrha'e dec Hct,inc BCClinical %roblems enco#ntered

Shoc1 from the %lasma lea1a'e Se$ere hemorrha'e r'an im%airment

CRITICAL PHASE


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Grad#al re>absor%tion of e)tra$asated (#id+0>L2 ho#rs-

PatientsQ 'eneral "ellbein' im%ro$es,

hemodnamic stat#s stabili:es anddi#resis ens#es*

Hct stabili:es or ma be lo"er +dil#tione9ect of reabsorbed (#id-

After defer$escence rise in BC then%lateletClinical %roblems enco#ntered

H%er$olemia

RECOVERY PHASE

COURSE OF DENGUE ILLNESS


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COURSE OF DENGUE ILLNESS

CBC@+ @+

AM@+ PM @+,-

AM@+,- PM @+,, AM


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AM AMBC 2*2 2* 7*2 0*7 0* 6*=&e#t 62*7 *7 24 70*7 20*6 4*Lm 22*2 2L*2 L0 0 60*7 6=*7

?ono 4* 4L* 25*L 44* 4*5Eosi 5 5 5 5 5 5Baso 5 5 5 5 5 58BC 0*L 0*4 0*7L 0*0 0*46 0*5H'b 4*2 40*0 40*4 47* 47*2 47*4Hct 04*4 05*4 7L*L 7*7 7*= 7*6

?CN L*0 6*L 6*7 L 6*7 L*=?CH 72*7 74*= 72*7 74*0 74*L 72*7?CHC 7L*5 76* 7L*0 76 76* 76*8@ 42*= 47*4 42* 42* 42* 42*Plt 226 46= =0 426 =L 4LBT c 8h

PT 42*Control 40*6

Act 440*5

6

I&8 5*

PTT 2*0


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, ? < @ 5@+9 * 5@+9120it

5@+,-9 = 5@+,,9 5@+,?9

STAGE Febrile Critical 8eco$er @ISCHA8GE@

TE?P* ndoc#mented 76*576*076*

76*L

FENE8

76*L76*

SS) Fe$erHeadache?al'iaArthral'ia

Fe$erHeadache?al'iaArthral'ia

Fe$erHeadache?al'iaArthral'iaA#2o0i&1! )1i&Vo0iti&'

sis offe$erHeadacheAbdominal %ain

E%i'astric %ainHeadache

&o ab%ain

E%i'astric %ain

Ab %ain

BC+inc-

2*2 2* 7*2 0*7 0* 6*=

PTC&T

226 46=

=0 426

=L 4L

HCT+dec-

04*4 05*4

7L*L

7*7

7*=

7*6

Serolo' I'G


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CBC "ith Platelet co#nt dail #ntilthe critical %hase is o$er Hematocrit +earl %hase- baseline

BC decreasin' M Platelet co#nt


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MANAGEMENT

r"su0) /" 1'&os s% Li/" i&+tr1/"! to "&2"0i1r"1


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ASSESSM

ENT

F"/"r 1&2 ? o4 t(" % A&or"7i1 1&2 N1us"1 R1s(

A("s 1&2 )1i&s50y1!'i1 1rt(r1!'i19

W1r&i&' si'&s L"uo)"&i1 Tour&i3u"t t"st

)ositi/"

W1r&i&' Si'&s% A#2o0i&1! )1i&+t"&2"r&"ss P"rsist"&t /o0iti&' C!i&i1! ui2 1u0u!1tio&

Muos1! #!""2 L"t(1r'y 1&2 r"st!"ss&"ss Li/"r "&!1r'"0"&t ?0 L1#% i& Ht o&urr"&t :it(

r1)i2 2"> o4 Pt ou&t


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W1r&i&' Si'&s6

o"7isti&' o&2itio&soi1! iru0st1&"

Co6"7isti&' o&2itio&st(1t 01y 01$" 2"&'u"

Soi1!iru0st1&"s


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t(1t 01y 01$" 2"&'u"or its 01&1'"0"&t

0or" o0)!i1t"2

iru0st1&"s

Pre'nanc infanc ld a'e

besit @iabetes mellit#s H%ertension Heart fail#re

8enal fail#re Chronic hemoltic

diseases s#ch as sic1le>cell disease and

a#toimm#ne diseases

li$in' alone li$in' far from a

health facilit

"itho#t reliablemeans of trans%ort

Warning Signs

6 Coeisting conditionsSocial circ!mstance

DENGUEWITHOUT

G8P A?A BE


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Grou) Crit"ri1 L1#or1toryT"sts

Tr"1t0"&t Mo&itori&'

Patients "ho donot ha$e "arnin'si'ns

AND"ho are able To tolerate

adeAd $ice for immediateret#rn to

hos%ital ifde$elo%ment of an"arnin' si'ns3 ritten ad$ice of

mana'ement +e*'*home care card forden'#e-

WITHOUTWARNING

SIGNS

SE&TH?E

8A 8EH@8ATI&


89/101

8A 8EH@8ATI&&TES

Or1! r"(y2r1tio& so!utio& 5


90/101

Coeisting conditionsSocial circ!mstance

Grou) Crit"ri1 L1#or1tory T"sts

Tr"1t0"&t5without

warning sign"

Tr"1t0"&t5:it(

W1r&i&'

si'&s9

Coe)istin' conditons3socialcirc#mstance

OR E)istin' "arnin' si'ns

Abdominal %ain or

tenderness Persistent $omitin' Clinical (#id

acc#m#lation ?#cosal bleedin' ethar'3 restlessness i$er enlar'ement

2cm

F#llbloodCo#nt+FBC-

Haemat

ocrit+Hct -

Enco#ra'ementfor oral (#ids

If nottolerated,startintra$eno#s

(#id thera%5,= saline or8in'er actateat maintenancerate

S"" &"7ts!i2"

NGUE WITHOUT WARNING SIGNS DENGUE WITH WARNING SIGN

G8P B8EFE88E@ F8

I&>HSPITACA8E


91/101

Tr"1t0"&t 5:it( :1r&i&'

si'&s9 btain reference Hct before(#id thera%

Gi$e isotonic sol#tions s#ch as

5,= saline, 8in'er lactate,start "ith >L ml31'3hr for 4>2 ho#rs

Then red#ce to 7> ml31'3hrfor 2>0 hr

red#ce to 2>7 ml31'3hr or less

accordin' to clinical res%onse


92/101

R"1ss"ss !i&i1! st1tus

1&2 r")"1t Ht If Hct remains the same orrises onl minimall >contin#e "ith 2>7 ml31'3hr

for another 2>0 ho#rs If "orsenin' of $ital si'ns

and ra%idl risin' Hct >

increase rate to >45ml31'3hr for 4>2 ho#rs

R"1ss"ss !i&i1! st1tus


93/101

R"1ss"ss !i&i1! st1tusr")"1t Ht 1&2 r"/i": ui2

i&4usio& r1t"s 1or2i&'!y % 8ed#ce intra$eno#s (#ids'rad#all "hen the rate of%lasma lea1a'e decreasesto"ards the end of the critical%hase*

T(is is i&2i1t"2 #y%

Ade


94/101

5:it(out :1r&i&'si'&s9

5:it( :1r&i&' si'&s9

Tem%erat#re %atternNol#me of (#id inta1eand

osses rine o#t%#t W

$ol#me and fre


95/101

Grou) Crit"ri1 L1#or1tory T"sts Tr"1t0"&t Mo&itori&'

Patients "ith an ofthe follo"in'

feat#res* Se$ere %lasma

lea1a'e "ithshoc1 and3or (#idacc#m#lation"ith

res%iratordistress

Se$ere bleedin'

Se$ere or'an

F#ll bloodCo#nt +FBC-

Haematocrit+Hct -

ther or'anf#nctiontests asindicated

See net slide See netslide

DENGUE8EI8EE?E8GE&CT8EAT?E&T

"2


96/101

Start I*N* (#id res#scitation "ithisotonic ryst1!!oi2sol#tions at *6

,- 0!+$'+(r o$er , (r 8eassess %atientQs condition

T

r"1t0"

&to4o0)"&s1t"

s

(o$

I4 )1ti"&t i0)ro/"s% I N (#ids sho#ld be red#ced

'rad#all to *6=ml31'3hr D 4>2 hr

0 hr and> Then red#ced f#rther de%endin'

on hemodnamic stat#s

I N (#ids can be maintained for #%

(o

I4 )1ti"&t sti!! u&st1#!"% Chec1


97/101

1

t0"&to4o0)

"&s1t"

2s( I4 )1ti"&t sti!! u&st1#!"% Chec1

Hct after rst bol#s

I4 Ht i&r"1s"s3 still hi'h +5-re%eat a second bol#s of

crstalloid sol#tion at ,-6?-

0!+$'+(r 4or , (rIf im%ro$ement after secondbol#s, r"2u" r1t" to =6,-0!+$'+(r 4or ,6? (r contin#e to

red#ce as abo$e*

I4 Ht 2"r"1s"sThis indicates #!""2i&'and

need to cross>match and

(o


98/101

Initiate I*N* (#id res#scitation

"ith crstalloid or colloidsol#tion at 25 ml31' as a bol#sfor 4 min*

1

t0"&t

o4(y)ot"&si/"s(

I4 )1ti"&t i0)ro/"s% Gi$e a crstalloid 3 colloid

sol#tion of ,- 0!+$'+(r 4or ,

(r, then red#ce 'rad#all*

o$I4 )1ti"&t sti!! u&st1#!"%

8 i th H t t 1 b f th t


99/101

Tr"1t0"&

to4(y)

ot"&si/"

s(o8 e $ie" the Hct ta1en before the rst

bol#s

I4 Ht :1s !o: 5J@-. i& (i!2r"& 1&212u!t 4"01!"s J @*. i& 12u!t 01!"s9this indicates bleedin', the need to

crossmatch and transf#se

I4 HCT :1s (i'( o0)1r"2 to t("#1s"!i&" /1!u"%Chan'e to IN colloids at ,-6?- 0!+$' as

a second bol#s o$er to 4 ho#rM reassessafter second bol#sIf i0)ro/i&'red#ce the rate to L>45

ml31't3hr for 4>2 ho#rs, then bac1 to INcrstalloids and red#ce rates as abo$e

I f condition still #nstable, re%eat Hct

Tr"1t0"&t o4 (y)ot"&si/" s(o$


100/101

Tr"1t0"&t o4 (y)ot"&si/" s(o$

Tr"1t0"&t o4 (1"0orr(1'io0)!i1tio&s%Gi$e >45 ml31' of fresh %ac1edred cells or 45>25 ml31' fresh "holeblood *

DISCHARGE CRITERIA


101/101

DISCHARGE CRITERIA

A!! o4 t(" 4o!!o:i&'rit"ri1 0ust #")r"s"&t %

&o fe$er for 0 ho#rs

Increasin' trend of %lateletco#nt

Stable hematocrit "itho#tintra$eno#s (#ids

Dengue Fever Case Reporting

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