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THE VECTOR

Ê    
MODE OF
TRA MààO :
Mosquito bite

à CUBATàO PERàOD:
13 to 14 days, following
an acute phase that lasts
for about 5 to 7 days.
m main pathophysiological
changes that occur in DHF

-vascular permeability

-Disorder in hemostasis
h vascular permeability

Loss of plasma from the


vascular compartment

Hemoconcentration, low
pulse pressure, and
other signs of shock

Disorder in hemostasis
Tourniquet Test
(Rumpel Leads Test)

-ànflate the blood pressure cuff on the


upper arm to a point midway
between systolic and diastolic
pressure for 5 minutes.
-Release cuff and make an imaginary
m.5 cm. quare inch or 1 inch square
just below the cuff, at the antecubital
fossa.
-Count the number of petechiae
inside the box.
-A test is (+) when m or more
petechiae per m.5 cm square or 1
inch square are observed.
° RIL OR
INVASIV STAG
ÈFirst 4 days
Èstarts abruptly as high
fever, abdominal pain
and headache; later
flushing which may be
accompanied by
vomiting, conjunctival
infection and epistaxis.
Toxic or Hemorrhagic
stage
È4th to 7th days
È lowering of temperature,
severe abdominal pain, vomiting
and frequent bleeding from
gastrointestinal tract in the form
of hematemesis or melena.
È Unstable b.p., narrow pulse
pressure and shock. Death may
occur. Tourniquet test which may
be positive on the third day may
become negative due to low or
vasomotor collapse.
§ONVAL S§ NT OR
R §OV RY STAG

D7th-1 th day

Dgeneralized flushing
with interventing areas
of blanching appetite
regained strength and
b.p. already stable.
±arning igns for Dengue hock
Alarm Signals:
D evere abdominal pain
D Prolonged vomiting
°our §riteria for DH°: D Abrupt change from
D Fever fever
D Hemorrhagic manifestations to hypothermia
D Excessive capillary D Change in level of
permeability consciousness
D 1 , mm3 platelets (irritability
or somnolence)
Initial ±arning Signals:
D Disappearance of ±hen Patients Develop DSS:
fever D 3 to 6 days after onset of
D Drop in platelets symptoms
D àncrease in
hematocrit
§linical §ase Definition for
Dengue Hemorrhagic °ever

@  
 
1. Fever, or recent history of acute fever
m. Hemorrhagic manifestations
3. Low platelet count (1 , mm3 or less)
4. Objective evidence of ³leaky capillaries:´
å elevated hematocrit (m  or more over
baseline)
å low albumin
å pleural or other effusions
°our Grades of DH°
È Grade 1
å Fever and nonspecific constitutional symptoms
å Positive tourniquet test is only hemorrhagic
manifestation
È Grade 2
å 'rade 1 manifestations + spontaneous
bleeding
È Grade 3
å igns of circulatory failure (rapidweak pulse,
narrow pulse pressure, hypotension,
coldclammy skin)
È Grade 4
å Profound shock (undetectable pulse and BP)
Danger igns in
Dengue Hemorrhagic Fever

È Abdominal pain - intense and


sustained
È Persistent vomiting
È Abrupt change from fever to
hypothermia, with sweating and
prostration
È Restlessness or somnolence
1. Because Dengue hemorrhagic
fever is caused by a virus for
which there is no known cure or
vaccine, the only treatment is to
treat the symptoms.

m. Rehydration with àV fluids is often


necessary to treat dehydration.

3. àV fluids and electrolytes are also


used to correct electrolyte
imbalances .
4. A transfusion of fresh blood or
platelets can correct bleeding
problems.

5. Oxygen therapy may be needed


to treat abnormally low blood
oxygen.

6. For fever, give paracetamol for


muscle pains. For headache, give
analgesic. DO OT give APàRà .

7. àncludes intensive monitoring and


follow-up.