2. • To differentiate DHF from DF
• Assessing onset of Critical Phase of DHF
• Smooth manipulation of fluids averting
prolonged shock and fluid overload
• Early detection of complications
• Recognition of unusual presentations
3. • Pulse rate
• Pulse pressure
• CRFT
• Respiratory rate
• FBC - HCT
• Intensity of monitoring depends on
• Phase of the illness
• Severity
• Aggressiveness of fluid therapy
• Accurate fluid balance charts
7. • Dengue or not?
– Clinical
– FBC
• Leucopaenia + thrombocytopaenia
• DF or DHF ?
– Plasma leakage + or –
• If DHF – what is the phase ?
8. • Critical phase
– Time of entry
– Predicted time of end
• Aggressive monitoring
• Calculate the fluid quota
• Dynamic approach to fluid therapy
• Final diagnosis – precise (DF or DHF &
grade)
9. • Dropping Platelets
• HCT rise of more than 20% of base line
Conforms DHF as it signify leak.
Even If
HCt rise less than 20% but pleural
effusion/ascites present conforms
diagnosis of DHF/DSS( it is mostly due to
early volume replacement or bleeding).
10. • Febrile phase
• Critical phase
• Convalescent phase
• Day of the illness ?
• Evidence of plasma leakage ?
• Convalescent rash ?
Assess
11. • Detection of shock
• Pulse pressure < 20 mm Hg
• CRFT > 2 secs
• HCT increase of 20% or more from baseline
• Efficacy of IV fluid therapy
• Pulse pressure, capillary refill time, hypotension
• To keep urine output at least 0.5 – 1.0 ml/kg/hr
• Early detection of Fluid overload
• Respiratory rate > 20/mt
• Lung bases
• SaO2 < 92%
• CXR
12. •Misjudging of critical phase
which could begin as early as day 3 (if
fever
drop on day 3).
• Delay in doing the WBC, platelets and Hct
determinations.
which help predict the critical stage/shock
21. • Be vigilant to recognize DSS as most of
the patients remain in good conscious and
have narrow pulse pressure with
increased diastolic
pressure(e.g.BP=110/90, 100/80mm Hg)
without hypotension.
• Avoid misdiagnosis of DHF in Infants(<1
year) with fits as sepsis/infection followed
by LP leading to bleeding/
hematoma(platelets )
22. • Your initial timing of critical phase may
prove to be sometimes wrong
Be prepared to
change what you decided earlier or shift
the timing based on more information you
receive while Mx.
23. • Try to Master the ways of giving
‘ THE SMOTHEST AND THE MOST
UNEVENTFUL RECOVERY’ for the
patient.
• Avoid both shock and fluid overload.
• Keep ‘CHECKING ON A TIME SCALE’…
R u heading for fluid overload? If so,
switch to a colloid.
24. • At ‘END OF LEAKING PHASE’ even if
PCV is high but patient is well, pulse, BP
is OK
• Don’t try to correct PCV as re absorption
will start soon and PCV will come down
so..
WAIT.
25. •About 60% of DSS can be successfully
resuscitated by using crystalloid solution only,
20% need colloidal and 15% need blood
transfusion (+blood components).
•With rapid recognition of shock and proper
treatment rapid and dramatic recovery is the
rule