Dengue Case

Date & Time < Admission Clerking >

Age / Race / Sex

- U/l, NKMI, NKDFA

- Smoker? Non-smoker?

NS1 – positive, combokit panel -

p/w

- fever (day of onset)

------- documented temperature at home/ED? PCM taken? h/o visiting GP / private clinic / a/w
chills & rigors?

- Nausea / vomiting / diarrhea

* How many episodes in a day, watery or bloody?

- Abdominal pain

- Headache

- Retro-orbital pain

- Arthralgia / myalgia

- Rash

- Bleeding tendencies (epistaxis, gum bleeding, menorrhagia, haematuria)

- Reduced oral intake

- Last PU @ ___ am/pm, frequency, volume (oliguria?) – Concentrated?

- H/o jungle trekking / swimming in waterfall

- H/o contact with rodents

- H/o sick contact at home / family members

- H/o taking outside food

- Recent fogging in neighbourhood / dengue-prone area

Other components of history taking:

 Past Medical / Surgical History

 Drug / Allergy History
 Family History
  Social History / Epidemiological History

At ED

- FBC stat, VBG stat

- Repeated FBC after bolus, VBG

- Vital signs

In ward

O/E

- Alert, conscious (mental state, GCS score), dehydrated? Pulse volume? Capillary refill time <
2s? , warm peripheries, not tachypnoiec

Input - , output- , balance, urine output:

Vital signs: BP (pulse pressure), Pulse, Temperature, RR, SpO2

Lungs: Clear

CVS: DRNM

Abdomen: Soft, non-tender, no hepatomegaly, no shifting dullness

Impression: DF, Day __ of illness, in febrile/critical/recovery phase with warning signs (………..)

Ix

FBC (HCT), VBG

Plan

1. Strict I/O
2. Watch out for warning signs
3. Encourage orally

< AM / PM / On-call review>

Age / Race / Sex

Diagnosis: DF, Day __ of illness, in febrile/critical/recovery phase with warning signs (………..)

Currently/ Progress,

 No fever
 No abdominal pain
 No vomiting , no loose stools (diarrhea)
 No bleeding tendencies
  Tolerating orally well

O/E: alert, full GCS, not tachypnoiec, CRT < 2s, warm peripheries, good pulse volume

Lungs: Clear

CVS: DRNM

Abd: Soft, non-tender , no ascites

Vital signs:

Input, output, balance, urine output

Ix: FBC trend

Plan

- Strict I/O charting

- Encourage orally

- Watch out for warning signs

Transaminitis: AST / ALT daily

Dengue PCR, dengue IgM

Reminder:

1. Update DENGUE CHART every 4 – 6 hours

2. Send PCR form & dengue IgM (day___)
3. Send notification form as soon as possible
4. Dengue QID (6 am , 12 pm , 6 pm , 12 am)

ACUTE CUBICLE

Normal Compensated Shock Decompensated Shock

 Clear consciousness  Clear consciousness  Altered mental status
 Capillary refill time  Prolonged capillary  Prolonged capillary
<2s refill time refill time
 Warm and pink  Cool peripheries  Cold, clammy
peripheries  Weak and thread peripheries
peripheral pulses  Feeble (weak) and
 Tachycardia absent peripheral
 Normal systolic pulses
pressure with raised  Severe tachycardia ,
diastolic pressure bradycardia in late
 Postural hypotension shock
 Narrowing pulse  Hypotension/
pressure unrecordable BP
 Tachypnea  Narrowed pulse
pressure
 Reduced urine  Metabolic acidosis
output (Kussmaul’s
 Increased thirst breathing)
 Oliguria / anuria