Professional Documents
Culture Documents
To
Specific Objective
To
Pertinent (+)
Pertinent (-)
3 days PTA
Sudden onset
of documented
fever (39.3C)
Vomiting of 2-3
episodes
of
previously
ingested food
7 hours PTS
No
No
No
No
Cough
LBM
Dysphagia
Dysuria
Remarks
No consult
Paracatemol
1tbsp 3x a day
No meds taken
Sought consult
at private MD
and was
advised
admission
previous hospitalization
No surgical history
No known allergies to food or
medications
FAMILY HISTORY
Immunization Status
Patient
is completely immunized
single dose BCG
3 doses of DPT, OPV and Hepa-B vaccines
single dose of measles vaccine
Feeding History
Review of System
General:
Physical Examination
VITAL SIGNS:
T: 36.3 C
Pulse Rate: 123 bpm
Respiratory Rate: 29 cycles per minute
BP: Palpatory 70
Stunting:
Wasting
(+) Tourniquest test
Physical Examination
SKIN: (+) petechiae, ecchymoses, no wounds
HEENT:
Physical Examination
CHEST
& LUNGS
Equal chest expansion, No retractions; No lesions, No
tenderness; No mass; Clear breath sounds
CARDIOVASCULAR
Upper Quadrnt
EXTREMITIES
and thready
Clinical Impression
Dengue
Shock Syndrome
Basis
History
Sudden
Differential Diagnoses
Ruled- In
1. Acute
TonsilloPharyngitis
(+) Fever
2. Urinary Tract
Infection
(+) Fever
(+) vomiting
(+) abdominal pain
3. Typhoid fever
(+) Fever
4. Malaria
(+) Fever
Ruled- Out
(-) Dysphagia
(-) swollen tonsils
(-) dysuria
VS:
Bp: Palpatory 70
T: 36.3C
P: 123 bpm
R: 29cpm
O2sat: 96%
Awake, weak-looking,
cold and clammy skin
AS, PPC, (+) sunken
eyeballs
ECE, CBS
AP. Tachycardic, (-)
murmur
Flat, NABS, (+)
tenderness RUQ
Poor and thready
pulses
(+) Tourniquet test
Dengue Shock
Syndrome
P
Admit to W8-ICU
DAT except dark
colored food
IVF: PLR1L to run @
36gtts/min x 2hrs
then refer for RA
Start another line
with PNSS 1L to run
@ 400cc FDx 2 then
refer for RA
Labs:
-CXR APL
- Cbc, plt, BT
-serial hct/plt q6
-dengue NS1
Meds:
Paracetamol 200mg
IVT PRN q 4 for
T>38
Ranitidine 14mg IVT
now then q8
Monitor VS and BP
q1
Monitor I and O q
VS:
Bp: 110/80
T: 36.5C
P: 120 bpm
R: 25cpm
O2sat: 96%
Awake, weak-looking,
AS, PPC, (+) sunken
eyeballs
ECE, CBS
AP. Tachycardic, (-)
murmur
Flat, NABS, (+)
tenderness RUQ
Good pulses
TFI: 5cc/kg
Dengue Shock
Syndrome
VS:
Bp: 100/70
T: 36.5C
P: 111 bpm
R: 25cpm
O2sat: 96%
Awake, NIRD
AS, PPC, (-) sunken
eyeballs
ECE, CBS
AP. Tachycardic, (-)
murmur
Flat, NABS, (+)
tenderness RUQ
Good pulses
Hct: 0.50
Plt: 20
BT: B +
TFI: 5cc/kg
Dengue Shock
Syndrome
VS:
Bp: 90/60
T: 36.5C
P: 11 bpm
R: 22cpm
O2sat: 96%
Dengue Shock
Syndrome
TFI: 5cc/kg
Awake NIRD
AS PPC
ECE, CBS
AP, tachycardic
Globular, NABS, (+)
RUQ tendrness
Good pulses
VS:
Bp: 90/60
T: 37C
P: 100 bpm
R: 28cpm
O2sat: 99%
TFI: 5cc/kg
Awake NIRD
AS PPC
ECE, CBS
AP, NRRR, (-) murmur
Globular, NABS, (+)
RUQ tenderness
Good pulses
UO: 100ml
Hct: 0.50
Plt: 18
Dengue Shock
Syndrome
VS:
Bp: 90/60
T: 36.9C
P: 115 bpm
R: 23cpm
O2sat: 99%
TFI: 7cc/kg
Awake NIRD
AS PPC
ECE, CBS
AP, NRRR, (-) murmur
Globular, NABS, (+)
RUQ tenderness
Good pulses
UO:
Hct: 0.52
Plt: 20
Dengue Shock
Syndrome
VS:
Bp: 110/80
T: 36.5C
P: 100 bpm
R: 27 cpm
O2sat: 99%
TFI: 7cc/kg
Awake NIRD
AS PPC
ECE, CBS
AP, NRRR, (-) murmur
Globular, NABS, (+)
RUQ tenderness
Good pulses
UO:
Hct: 0.55
Plt: 20
Dengue Shock
Syndrome
VS:
Bp: 190/60
T: 36.5C
P: 106 bpm
R: 24 cpm
O2sat: 99%
Dengue Shock
Syndrome
TFI: 7cc/kg
Awake NIRD
AS PPC
ECE, CBS
AP, NRRR, (-) murmur
Globular, NABS, (+)
RUQ tenderness
Good pulses
UO:
Hct: 0. 55
Plt: 20
VS:
Bp: 90/60
T: 36.5C
P: 100 bpm
R: 25 cpm
O2sat: 99%
TFI: 7cc/kg
Awake NIRD
AS PPC
ECE, CBS
AP, NRRR, (-) murmur
Globular, NABS, (+)
RUQ tenderness
Good pulses
UO:
Hct:
Plt:
Dengue Shock
Syndrome
VS:
Bp: 100/60
T: 36.3C
P: 100 bpm
R: 25 cpm
O2sat: 99%
TFI: 5cc/kg
Awake NIRD
AS PPC
ECE, CBS
AP, NRRR, (-) murmur
Globular, NABS, (+)
RUQ tenderness
Good pulses
UO:
Hct: 0.41
Plt: 13
Dengue Shock
Syndrome
VS:
Bp: 90/60
T: 36.3C
P: 100 bpm
R: 25 cpm
O2sat: 99%
TFI: 3cc/kg
Awake NIRD
AS PPC
ECE, CBS
AP, NRRR, (-) murmur
Globular, NABS, (+)
RUQ tenderness
Good pulses
UO:
Hct:
Plt:
Dengue Shock
Syndrome
VS:
Bp: 100/70
T: 36.3C
P: 105 bpm
R: 23 cpm
O2sat: 99%
TFI: 3cc/kg
Awake NIRD
AS PPC
ECE, CBS
AP, NRRR, (-) murmur
Globular, NABS, (+)
RUQ tenderness
Good pulses
UO:
Hct:
Plt:
Dengue Shock
Syndrome
VS:
Bp: 100/70
T: 36.3C
P: 110 bpm
R: 47 cpm
O2sat: 99%
TFI: 2cc/kg
Awake NIRD
AS PPC
ECE, dec breath
sounds Bibasal
AP, NRRR, (-) murmur
Globular, NABS, (+)
RUQ tenderness
Good pulses
UO:
Hct:
Plt:
Dengue Shock
Syndrome T/C pleural
effusion
VS:
Bp: 100/70
T: 36.8C
P: 70 bpm
R: 28 cpm
O2sat: 99%
TFI: 2cc/kg
Awake NIRD
AS PPC
ECE, dec breath
sounds Bibasal
AP, NRRR, (-) murmur
Globular, NABS, (+)
RUQ tenderness
Good pulses
UO:
Hct:
Plt:
Dengue Shock
Syndrome; pleural
effusion
VS:
Bp: 100/70
T: 36.8C
P: 102 bpm
R: 26 cpm
O2sat: 99%
TFI: 2cc/kg
Awake NIRD
AS PPC
ECE, dec breath
sounds Bibasal
AP, NRRR, (-) murmur
Globular, NABS, (+)
RUQ tenderness
Good pulses
UO:
Hct:
Plt:
Dengue Shock
Syndrome; pleural
effusion
CASE DISCUSSION
Dengue is the most rapidly spreading
mosquito-borne viral disease in the world
Dengue virus (DEN) is a small singlestranded RNA virus comprising four distinct
serotypes
(DEN-1 to -4).
Belongs to Flaviviridae family
CASE DISCUSSION
Transmission of Dengue virus is primarily
transmitted
by
Aedes
mosquitoes,
particularly Aedes Aegypti. Other Aedes
species that transmit the disease include:
1.
2.
3.
Aedes Albopictus,
Aedes Polynesiensis
Aedes Scutellaris.
The Host
Humans
virus
Incubation period: 4-10 days
Probable dengue
Live in/travel to dengue endemic area. Fever and 2 of the following criteria:
Nausea, vomiting
Rash
Aches and pains
Tourniquet test positive
Leucopenia
Any warning sign
Laboratory confirmed
dengue
(important when no sign of plasma
leakage)
Febrile Phase
The
cell count
CLINICAL SIGNS AND SYMPTOMS
Critical Phase
Defervescence
Recovery Phase
A
Confirmed dengue:
Viral culture isolation
PCR
PARACLINICALS
CBC,
Management
Action Plan
Oral rehydration solution (ORS) should be given based on weight,
using currently recommended ORS:
Reduce osmolarity of ORS containing sodium 45 to 60 mmol/liter
Sports drinks should NOT be given due to its high osmolarity
which may cause more danger to the patient.
Calculation of Oral Rehydration Fluids Using Weight (Ludan
Method)
Body weight (kg) ORS to be given
>3-10 100 mL/kg/day
>10-20 75 mL/kg/day
>20-30 50-60 mL/kg/day
>30-60 40-50 mL/kg/day
Management
GROUP
Management
Management
f
Management
b. Dengue with Warning Signs
1. Obtain a reference hematocrit before fluid therapy
2. Give only isotonic solutions such as 0.9% NaCl (saline),
Ringers Lactate, Hartmanns solution.
Start
Management
b. Dengue with Warning Signs
6. Reassess the clinical status, repeat hematocrit and review
fluid infusion rates accordingly
7. Give the minimum intravenous fluid volume required to
maintain good perfusion and urine output of about 0.5
mL/kg/hr. Intravenous fluids are usually needed
for only 24 to 48 hours.
8. Reduce intravenous fluids gradually when the rate
of plasma leakage decreases towards the end of the
critical phase. This is indicated by:
Urine output and/or oral fluid intake is/are adequate,
or
Hematocrit decreases below the baseline value in
a stable patient