Dengue fever physical examination: Difference between revisions

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==Overview==
==Overview==
The physical examination in Dengue fever should be directed to ward identifying signs that the patient has severe disease warranting admission or in-hospital observation.


==Physical Examination==
==Vital Signs==
[[Tachycardia]], [[postural hypotension]], and [[hypotension]] could indicate [[dehydration]].  Patients who are triaged to home management should urinate at least every 6 hours.
==Mental Status==
Lethargy


==Abdomen==
▸  Group criteria
❑ Patients with any of the warning signs:
  ❑ Abdominal pain or tenderness
  ❑ Persistent vomiting
  ❑ Clinical fluid accumulation
  ❑ Mucosal bleed
  ❑ Lethargy, restlessness
  ❑ Liver enlargment >2 cm
  ❑ Increase in hematocrit with rapid decrease in platelet count
▸  Laboratory tests
▸  Management
▸  Monitoring
Group C (Require emergency treatment)
▸  Group criteria
❑ Patients with any of the warning signs:
  ❑ Abdominal pain or tenderness
  ❑ Persistent vomiting
  ❑ Clinical fluid accumulation
  ❑ Mucosal bleed
  ❑ Lethargy, restlessness
  ❑ Liver enlargment >2 cm
  ❑ Increase in hematocrit with rapid decrease in platelet count
▸  Laboratory tests
▸  Management
The physical examination should include:
The physical examination should include:
• assessment of mental state;
• assessment of mental state;

Revision as of 19:11, 14 June 2014

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The physical examination in Dengue fever should be directed to ward identifying signs that the patient has severe disease warranting admission or in-hospital observation.

Vital Signs

Tachycardia, postural hypotension, and hypotension could indicate dehydration. Patients who are triaged to home management should urinate at least every 6 hours.

Mental Status

Lethargy

Abdomen

▸ Group criteria

❑ Patients with any of the warning signs:

  ❑ Abdominal pain or tenderness
  ❑ Persistent vomiting
  ❑ Clinical fluid accumulation
  ❑ Mucosal bleed
  ❑ Lethargy, restlessness
  ❑ Liver enlargment >2 cm
  ❑ Increase in hematocrit with rapid decrease in platelet count

▸ Laboratory tests

▸ Management

▸ Monitoring

Group C (Require emergency treatment)

▸ Group criteria

❑ Patients with any of the warning signs:

  ❑ Abdominal pain or tenderness
  ❑ Persistent vomiting
  ❑ Clinical fluid accumulation
  ❑ Mucosal bleed
  ❑ Lethargy, restlessness
  ❑ Liver enlargment >2 cm
  ❑ Increase in hematocrit with rapid decrease in platelet count

▸ Laboratory tests

▸ Management The physical examination should include: • assessment of mental state; • assessment of hydration status; • assessment of haemodynamic status (Textbox D); • checking for quiet tachypnoea/acidotic breathing/pleural effusion; • checking for abdominal tenderness/hepatomegaly/ascites; • examination for rash and bleeding manifestations; • tourniquet test (repeat if previously negative or if there is no bleeding manifestation).


Appearance of the Patient

The diagnosis of dengue is usually made clinically. The classic picture is high fever with no localising source of infection, a petechial rash with thrombocytopenia and relative leukopenia.

There exists a WHO definition of dengue haemorrhagic fever that has been in use since 1975; all four criteria must be fulfilled:

  1. Fever
  2. Haemorrhagic tendency (positive tourniquet test, spontaneous bruising, bleeding from mucosa, gingiva, injection sites, etc.; vomiting blood, or bloody diarrhea)
  3. Thrombocytopaenia (<100,000 platelets per mm³ or estimated as less than 3 platelets per high power field)
  4. Evidence of plasma leakage (hematocrit more than 20% higher than expected, or drop in haematocrit of 20% or more from baseline following IV fluid, pleural effusion, ascites, hypoproteinaemia)

Dengue shock syndrome is defined as dengue haemorrhagic fever plus:

  • Weak rapid pulse,
  • Narrow pulse pressure (less than 20 mm Hg)

or,

  • Hypotension for age;
  • Cold, clammy skin and restlessness.

References