9 years old girl with high grade fever and rash


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9 years old girl with high grade fever and rash

  1. 1. 9 years old girl with High Grade Fever and Rash 9 years old girl presented with complaint of fever for 5 days duration. There are no symptoms of URTI, UTI, AGE, ear discharge, altered mental status and fitting. Image Courtesy of Dr Dr Muna Athirah, Duchess of Kent HospitalOn examination, patient is alert and conscious. Questions 1) Describe your finding in the picturePulse: rate is 110, weak and volume is poor. 2) What is your complete provisionalCapillary refilling time: more than two seconds diagnosis?Peripheral examination: cold periphery 3) How do you diagnose dengue fever?BP: 90/40 4) Describe grading of dengue feverTemperature: 38 degree celcius, 5) Explain regarding phases of dengueLung, Cardiovascular and Abdominal feverexamination is unremarkable. 6) How do you manage this patientFBC was taken and the result are shown below: 7) What is the complication of dengueWBC:2.9 feverHb:14HCT:42Plt:60
  2. 2. Answer 1) Petichae with characteristic of “Islands 6) Grading of dengue fever of white in a sea of red” ** Usually during recovery phase.. 2) Dengue Hemorrhagic fever in critical phase with compensated shock ** Physician must able to identify provisional diagnosis of dengue, phase of illness, hydration and haemodynamic status (shock or not) and whether require admission ? Critical phase: Temperature starts to normalize, 3rd to 7th day of illness, 7) Management for this patient thrombocytopenia, hemoconcentration, leucopenia - Admit patient to the wards - Insert two large bore IV line, CBD ? Compensated shock: Clear consciousness, - fluid resuscitation 10-20 ml/ kg capillary refilling >2s, cool extremities, crystalloid blus weak and thready peripheral pulse, - QID FBC to monitor HCT and tachycardia platelet - Put patient on IV maintanence 3) Antibody detection (Dengue Serology - Repeat the bolus if no Test like Haemagglutination improvement. May repeat up to 3 Inhibition Test, Dengue IgM test, bolus (third one with colloids) Indirect IgG ELISA test, Dengue - 15-30 minutes vital sign Rapid tests), virus isolation, detection monitoring until stable, and then of virus genetic materials (polymerase 1-2 hourly chain reaction -PCR) and detection of - twice a day monitoring for dengue virus protein (NS1 antigen). warning sign, general well being (appetite/oral intake), bleeding 4) WHO Classification for Dengue Fever symptoms, neurological/ mental a) Dengue fever state b) Dengue Hemorrhagic fever - Hourly urine output monitoring mild (grade I and II) - Daily BUSE/Creat, LFT, RBS, Dengue shock syndromes (grade III Coagulation profile, Acid base and IV) imbalance - Admit patient to Intensive care 5) Complication unit if condition worsen. Consider - Acute abdomen blood product transfusion, - Hepatitis and liver failure inotropes. - Encephalitis or encephalopathy - Dengue notification form (24H) - Hypovolumic shock, DIC