0% found this document useful (0 votes)
6 views34 pages

Strategic Management of Dengue

It is about dengue management for medical help.

Uploaded by

rahat999201
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
0% found this document useful (0 votes)
6 views34 pages

Strategic Management of Dengue

It is about dengue management for medical help.

Uploaded by

rahat999201
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 34

Strategic Management of

Dengue
Fighting Dengue Outbreaks

Photo by Pexels
Table of
Contents

1. Dengue Fever

2. Dengue Haemorrhagic Fever

3. Dengue Shock Syndrome

4. Expanded Dengue Syndrome


1

Photo by Pexels
2
3

Scenario 01

A patient came with fever for 3 days,


● Dengue NS1 positive,
● rising Hct 10%/19%...mx?
4

Management plan for Group-A


patient
● These patients will be advised for home
management Advised for adequate bed rest.
● Adequate fluid intake (around 2500 ml or 8-10
glasses for average-sized adults or accordingly
in children, around 50 ml/kg)-e.g.
● Milk, fruit juice (caution with diabetic patients),
oral rehydration solution (ORS) or barley/rice
water/coconut water.
● Take paracetamol (not more than 3 grams per
day for adults; 10-15 mg/kg/dose, not more
than 3 to 4 times in 24 hours in children)
5
Management plan for Group-A
patient
Tepid sponging

● These patients will be advised to avoid


Acetylsalicylic acid (aspirin), Mefenamic acid,
Ibuprofen or other NSAIDs, Steroids, Antibiotics.
● These patients should be immediately taken to
the nearest hospital in 1st afebrile day with
worsening of the situation or if any warning sign
is observed.
● Observe urine output. If no urine output for 4–6
hours go immediately to nearby hospital.
6

Scenario 02

A dengue patient came With


● Bp 100/85,
● tachycardia,
● Hct >=20,
● Pleural effusion...mx?
7

Management plan for Group-B


patient
● Patients should be hospitalized
● Encourage for oral fluid intake
● Obtain a reference haematocrit before intravenous fluid
therapy begins
● Intravenous fluid therapy in DHF is crucial during the critical
period
Indication for IV fluid-
○ When the patient can’t have adequate oral fluid
intake or is vomiting
○ Haematocrit continues to rise 10%-20% despite oral
rehydration
○ Impending shock or shock
8
9

Scenario 03

A dengue patient came with,


● cool extremity,
● tachycardia,
● Bp 70/50,
● fainting
10
11

Management plan for Group-C


patient
Require emergency treatment with fluid
resuscitation
The goals of fluid resuscitation include:
● Improving central and peripheral circulation
–i.e. Decreasing tachycardia.
● Improving BP and pulse volume, warm and pink
extremities, a capillary refill time < 2 seconds.
● Improving end-organ perfusion – i.e. Achieving a
stable conscious level.
● Urine output ≥ 0.5 ml/kg/hour or decreasing
12

When to Start & Stop IV Fluid


Therapy
13

Compensated Shock Decompensated Shock


Clear consciousness Change of mental state,
restless, combative or lethargy
Cool extremities Cold, clammy extremities

Weak and thready peripheral Feeble or absent peripheral


pulse pulse
Tachycardia Severe Tachycardia with
bradycardia in late shock
Normal systolic pressure with Hypotension/ non-recordable
raised diastolic pressure BP
Reduced urine output Oliguria or anuria
14

Scenario 04

A dengue patient came with,


● Cold extremity,
● non recordable bp,
● feeble pulse…mx?
15
16
17

Expanded Dengue Syndrome


(Management Issues)
● These cases should be managed in tertiary care
setting by medicine specialist/pediatricians for
comprehensive care.
● In myocarditis with raised Troponin I and ECG
changes (Bradycardia, Tachycardia, ST-T changes)
injudicious use of antiplatelet, anticoagulant or
intervention (e.g. pacemaker and others) should be
avoided.
● In encephalitis, judicious use of steroids can be
18

Dengue Management in Pregnancy

● Admitting to hospital
● Hospital delivery is to be advised
● Avoid elective C/S
19

Dengue in case of Child

● Shock is to be managed by Normal Saline


● After shock managed, 5% DNS is to used for
maintenance
● Below 1 year age: Baby saline ( 0.45% NaCl) is
to be used
20

Dengue in CDK

● Patients with CKD have a low baseline


haematocrit and platelet count.
● As they have limited fluid tolerance, frequent
assessments of the haemodynamic state and
fluid regime adjustments are mandatory.
21

Dengue in CDK (Cont…)

● If metabolic acidosis and electrolyte


imbalance persist after adequate fluid
replacement, dialysis may be considered after
haemodynamic stability is achieved.
22

Cardiac Issues in Dengue

Ischemic Heart Disease


● Aspirin/clopidogrel should be avoided for
certain days, until the patient recovers from
DHF.
HTN
● Hypotension is a late sign of shock.
● The heart rate should not be used as an
assessment of perfusion in patients on ß-
23

Cardiac Issues in Dengue (Cont…)


Myocarditis
● Bed rest
● Restricted physical activity after discharge 2
to 4 weeks upto 6 months
Heart failure
● Fluid should be computed 50-75% of
maintenance depending on the degree of heart
failure.
● HF + Uncompensated shock due to
hypovolemia: Recommendation for fluid bolus
should be followed.
24

Dengue & Diabetes

● Hypoglycemia may occur in patients taking


oral hypoglycaemic agents (e.g. long-acting
sulphonylurea) who have poor oral intake.
● Hypoglycemia could be aggravated by
severe hepatitis from dengue.
● during the dengue illness, IV short- acting
insulin should be used.
25

Dengue & Diabetes (Cont…)

● Metformin should be discontinued during


dengue shock and in severe hepatitis, as it may
aggravate lactic acidosis.
● Target glucose level of <8.3 mmol/L should be
used.
26

Discharge Criteria

● No fever for at least 24 hours without the


usage of antipyretic drugs.
● At least two days have to be passed after
recovery from shock.
● Good general condition with improving appetite.
● Normal Hct. at baseline value or around 38 - 40
% when baseline value is not known.
27

Discharge Criteria (Cont…)

● No distress from pleural effusions


● No ascites
● Platelet count has risen above 50,000 /mm³
● No other complications
28

Vaccination

Two dengue vaccines have been licensed


● Dengvaxia® (CYD-TDV), developed by Sanofi
Pasteur
● Qdenga® (TAK-003), developed by Takeda.
Do’S Do Not
29

1. Administration of Paracetamol for high Send patients with non-severe dengue home
fever and myalgia with no follow-up and inadequate instructions

2. Clinical assessment of the Administer of acetylsalicylic acid (aspirin) or


haemodynamic status before and after ibuprofen
each fluid bolus

3. Give intravenous fluids for repeated Avoid clinical assessment of patient with
vomiting or a high rapidly rising respect to fluid therapy
haematocrit

4. Use the Appropriate isotonic Administer of intravenous fluids to any patient


intravenous fluids for severe dengue in with mild dengue (those who can take by
appropriate time and dose mouth)

5. Avoid intramuscular injections Give intramuscular injections to dengue


patients

6. Tight glycemic control Avoid monitoring blood glucose

7. Give appropriate colloid, PRC or Fresh Give excessive fluid, blood, and blood
30

Indications of Hospitalizations

● Restlessness or lethargy frequent vomiting one or two days


of febrile illness.
● Cold extremities or circumoral cyanosis. Bleeding in any
form.
● Rapid and weak pulse.
● Capillary refill time > 3 seconds.
● Narrowing of pulse pressure (<20 mm Hg) or Hypotension.
Hematocrit of 40 or rising hematocrit. Platelet count of <
1,00000/ mm3 Acute abdominal pain Evidence of Plasma
leakage. Eg. Pleural effusion /Ascities
31
Thank You

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy