Hye gais..
things they might not teach you about Dengue Fever
things they might not teach you about Dengue Fever
lets talk about warning signs... that you think is not warning signs
#1 Lethargy.. how lethargic is lethargic?
You see, most dengue fever comes with high grade fever (temp>38) and of course, the patient is bound to "feel" lethargic.
You see, most dengue fever comes with high grade fever (temp>38) and of course, the patient is bound to "feel" lethargic.
So semua pt yang kata penat tu ada warning sign.. so semua kena admit ke? its not like that. nnti penuh ward.
Lethargic ni bila pt nak ambulate requires aid.. mcm nak jalan pun org kena papah. thats lethargic.
Lethargic ni bila pt nak ambulate requires aid.. mcm nak jalan pun org kena papah. thats lethargic.
#2 Hemoconcentration.
ok cpg kata kalau hematocrit (hct) high seperti berikut:
male <60 yo = >46
male >60 yo = >42
Female all age = >40
But do you know, high hematocrit alone is not a warning signs. kalau high hct WITH low platelet baru considered as ONE warning sign.
ok cpg kata kalau hematocrit (hct) high seperti berikut:
male <60 yo = >46
male >60 yo = >42
Female all age = >40
But do you know, high hematocrit alone is not a warning signs. kalau high hct WITH low platelet baru considered as ONE warning sign.
Dulu masa HO, i clerk sorg pt lelaki umur 26, n discaj him. masa tu HCT dia 46 cun2 and plt dia 130. i missed the warning sign there. he came back next day, his condition deteriorated in ward and he passed away.
had i recognised the warning sign then, he might still be alive
had i recognised the warning sign then, he might still be alive
#3 vomiting and loose stool.
dear all, kalau nk consider warning sign yg ni, mesti at least 3 episodes of vomiting or loose stool for past 24H baru considered as warning sign. kalau muntah sekali tu bukan warning sign
dear all, kalau nk consider warning sign yg ni, mesti at least 3 episodes of vomiting or loose stool for past 24H baru considered as warning sign. kalau muntah sekali tu bukan warning sign
Other warning signs tu quite obvious n maybe x perlu explainantion.
also jgn lupa 3 golden question2 when you take history
1) total fluid intake
2) urination reduced or not
3) what is patient doing during the day
also jgn lupa 3 golden question2 when you take history
1) total fluid intake
2) urination reduced or not
3) what is patient doing during the day
kalau dekat ED, we got a luxury with USG. so many of us can scan to look for gall bladder wall thickening (>5mm) and pericholecystic collection. all are warning signs for dengue. so kalau u student or ho posting dekat ED, please ask MO ED utk ajar scan. time tu la nk blaja scan.
enough with warning signs, now how not to miss severe dengue. you see severe dengue ni bila dia affect target organ.
some pt, ada history of fever dtg dekat u with altered mental state.
initially you suspect meningitis. little did you know, the patient actually having dengue encephalitis. bila ambik blood all baru sedar its actually dengue. so kena ada high index of suspicion.
initially you suspect meningitis. little did you know, the patient actually having dengue encephalitis. bila ambik blood all baru sedar its actually dengue. so kena ada high index of suspicion.
most of dengue fever got tachycardia right. so let say sorg pt ni dtg dgn fever vomitng loose stool... but HR dia BRADYCARDIA let say 50bpm. check dengue sero positive dengue. so now what does this suggest?
It could be dengue myocarditis! also a severe dengue.
It could be dengue myocarditis! also a severe dengue.
of course kalau ada transaminitis, ALT AST sampai beribu also severe dengue. AKI? also severe dengue!
lepastu DSS, semua tahu dengue ni wajib you sentuh patient. CCTVR nk tahu perfusion pt okay or tak.
if BP low straight away pt tu decompensated shock.
kalau compensated shock ni kalau BP normal tapi perfusion (CCTVR) x okay.
look at the patient, not at the machine
if BP low straight away pt tu decompensated shock.
kalau compensated shock ni kalau BP normal tapi perfusion (CCTVR) x okay.
look at the patient, not at the machine
lepastu bila nk bagi blood, bila nak bagi colloid, bila nk tukar Hartmann?
Blood or packed cell ni bagi kalau despite fluid resus, HCT keep dropping n pt condition x improve. you terus kena suspect occult bleeding. so kena tx PC 10cc/kg until lactate improve
Blood or packed cell ni bagi kalau despite fluid resus, HCT keep dropping n pt condition x improve. you terus kena suspect occult bleeding. so kena tx PC 10cc/kg until lactate improve
colloid kalau pts still in shock despite fluid resus with crystaloid (NS). tp kalau nk bagi colloid, makesure pt is not in DIVC
Hartmann, kalau pt developed Hyperchloremic metabolic acidosis sebb kasi NS bnyk, yg ni kena kira Anion Gap. kalau normal AG tu kena suspect bnda ni la
Hartmann, kalau pt developed Hyperchloremic metabolic acidosis sebb kasi NS bnyk, yg ni kena kira Anion Gap. kalau normal AG tu kena suspect bnda ni la
tetiba rasa nk post pasal dengue sebb teringat kisah lama. masa belaja kat med school, selalu ambik mudah pasal warning sign, until you loose a patient bcoz of your own shortcomings.
please read CPG on dengue, and try not to loose your patient one day
please read CPG on dengue, and try not to loose your patient one day
oh yea, kalau you gais nk kasi fluid kat patient mcm 3cc/kg.. 5cc/kg wajib kira BMI patient dulu. kalau BMI >27, then kena kasi fluid per adjusted body weight (ABW). bnyk website boleh tlg kita ABW tu kalau x hafal formula.
manuelsweb.com/IBW.htm
manuelsweb.com/IBW.htm
lagi satu pasal dengue sero..
NS1 detectable in first 4-5days of illnesss,
IgM detectable after day 5 in 80% of cases. 93-99% detected at D6-D10
IgG detectable at D7 onwards
kalau first 4 days dengue sero negative, and you suspect dengue, then diagnosis now is probable dengue
NS1 detectable in first 4-5days of illnesss,
IgM detectable after day 5 in 80% of cases. 93-99% detected at D6-D10
IgG detectable at D7 onwards
kalau first 4 days dengue sero negative, and you suspect dengue, then diagnosis now is probable dengue
sebb first 4 days tu dengue sero memang boleh jadi negative. repeat serology day 5 onwards
kalau day 7 ke atas negative, then baru boleh kata negative
kalau day 7 ke atas negative, then baru boleh kata negative
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