Short instructions for dengue fever case management

outline

Epidemiology and Disease Management Department (EDCD) has announced new things. Short instructions for dengue fever case management Provides clear information about case definition, diagnosis and step -by -step guidelines for the treatment and monitoring of patients.

Dengue is one of the rebok viral diseases that are re -fused by AEDES mosquitoes. The characteristics of severe dengue fever include plasma leakage, bleeding and serious organ damage, resulting in serious complications and death.

Definition of case of dengue fever

Patients with at least two acute thermal diseases of the following symptoms and signs:

• Headache, retro track pain
• Muscle pain, Atra Nia
• Rash/exanthema
• Bisexiocytes test, skin bleeding and bleeding symptoms represented by mucosal bleeding
• Leukocyte reduction ≤4,000 cells/mm3 indicated by white blood cells
• Hematocrit 5-10%increased from the baseline.
• Platelets calculate ≤100,000/mm3

memo: Patients with acute heat, benign hemostatic tests and leukocyte reduction were 70-83%for dengue fever diagnosis.

Plasma leak diagnosis

If a patient with a dengue fever diagnosis or a dengue heat diagnosis occurs, one or more of the following occurs.

• Hemoconcension ≥20%
• Pleura and/or revenge and/or thickness of the gallbladder wall
• Serum Albuin is ≤4.0 g/dL in normal weight ≤3.5 g/dL or obesity.

Signs of clinical symptoms and severe dengue fever

Patients with dengue fever diagnosis or dengue fever occur when signs of one or more and severe dengue fever occur:

• Serious plasma leaks proven by the high or gradually rising hippopotamus that leads to shock or fluid accumulation (pleural or revenge) due to respiratory pain.
• Circulation failure represents fast and weak pulse, cold clamp skin, especially cold limbs and pulse pressure_≤20 mmHg.
• Low blood pressure hypotension using tissue hypotension indicates dizziness, stunning, fainting, reducing urine output, anxiety, changed sensor riges and capillary supplements> 2 seconds.

A warning signal for the development of severe diseases of dengue fever

• There is no clinical improvement and/or weaknesses when the fever subsides
• Abdominal pain or vomiting> 3 times/day (persistent vomiting)
• Mucosal bleed
• Changed senses, drowsiness, irritability, anxiety
• I refuse to eat or drink and we are crying
• Dizziness, faint, Ein Kero, cold clamp skin or sweat
• Reduce the amount of urine in 4-6 hours.

test

• Take the patient’s BP and record. Example 120/80 mm hg
• BP cuffs are expanded to the intermediate point between the systolic and the relaxation pressure (120+80) /2 = 100 mm HG.
• Wait for 5 minutes
• The test is considered positive when more than 10 petechiae is observed per square inch.
• The test can be negative or slightly positive in a profound shock stage with obese patients. After recovering from the shock, it is usually positive and sometimes strong.

Display of admission

If the patient has been diagnosed with dengue or dengue fever, there is one or more of the following:

• There is no clinical improvement and/or weaknesses when the fever subsides
• Abdominal pain, continuous vomiting and/or moderate appetite with severe dehydration
• Blood loss> 6-8 ml/kg (children) or> significant bleeding and duty indicated by 300 mL (adult)
• Reduced urine volume in 4-6 hours
• White blood cells are ≤ 4,000 cells/mm3 in high -risk groups (infants, elderly, pregnant women, long -term shocks, abnormal bleeding, fundamental diseases and neurological symptoms)
• Platelets calculate ≤ 100,000/mm3 with weakness and/or appetite.
• Hematologist rise ≥10%.

A display/emergency treatment is required to transfer dengue patients to recommended hospitals.

• Extended shock
• Signs of clinical symptoms and severe dengue fever
• Clinical symptoms and signs of fluid overload
• Significant bleeding
• High -risk groups (infants, elderly, pregnancy, obesity patients, bleeding, fundamental disease)
• AST/ALT> 500 U/L, changed senses, heart arrhythmia, etc.
• Beyond the hospital’s potential for treating patients, such as lack of medical staff, laboratory investigation that cannot be used, and lack of blood products in the vein or blood products.

Indications to start the fluid in the vein

• Constant vomiting patients
• Patients with severe dehydration in moderate
• In the critical stage where the hematologics have risen more than 10%, they reject patients with plasma leaks or to eat or drink.
• Dengue fever shock syndrome.

memo: *Patients with bleeding may have no rise in hematologics.

Dengue

Dengue fever has three stages of disease.

1. Train: Encourage I/V fluids as much as an average duration of 4 days (encourage as much oral intake as much as possible and I/V fluids.
2. Criminal/Leakage Stage: 24-48 hours after the enthusiasm
   A) The actual indicator for determining the critical step is the number of platelets ≤100,000/mm3.
3. Re-absorption/recovery stage: 3-5 days after critical stage
   A) Clinical symptoms and signs of recovery: A-apartment, B- Bradycardia, C- ActEncence Rash or Itching, D- Diuresis
   b) Recognize the fluid overload after 60 hours after the reinstallation of plasma outside the blood vessels starts to impact, or after 60 hours after ≤100,000/mm3.

Clinical and laboratory parameters for important step monitoring of dengue fever

The parameters for monitoring the critical stage of dengue fever are:

• objective: Consciousness, appetite, bleeding, abdominal pain, vomiting
• Vital signs:
  no way. Temperature: every 4-6 hours
  rain. BP, PR, PV, RR, capillary refilling time, cold clam skin/cold limbs: Non-impact patients every 1-3 hours.
  aspirate. BP, PR, PV, RR, SPO2, capillary refill time, cold clamp skin/cold limbs: -1 hours shock patient or stabilization every 15 minutes

• Hema Torch: If you are suspected of bleeding and more than 6-12 hours after blood transfusions.
• Urine output: For non-impact patients every 6-8 hours, for shock patients, keep the urine production at 0.5–1 ml/kg/h except for 1-4 hours (infants, obese patients and pregnant women.

General complications of dengue fever

In the next case (ABCSF):

• Patients with dengue fever with long shock
• Complex Cases: Institutional disorders (liver, kidney, etc.), bleeding, body fluid overload
• Patients with dengue heat shock syndrome without clinical improvement after receiving appropriate fluid resuscitation.

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