DO’S AND DON’TS FOR DOCTORS
• Cases of Dengue fever/Dengue Haemorrhagic Fever (DF/DHF) should be observed every hour.
• Serial platelet and haematocrit determinations drop in platelets and rise in haematocrits are essential for early diagnosis of DHF.
• Timely intravenous therapy – isotonic crystalloid solution can prevent shock and/or lessen its severity.
• If the patient’s condition becomes worse despite giving 20ml/kg/hr for one hour, replace crystalloid solution with colloid solution such as Dextran or plasma. As soon as improvement occurs, replace with crystalloid.
• If improvement occurs, reduce the speed from 20 ml to 10 ml, then to 6 ml, and finally to 3 ml/kg.
• If haematocrit falls, give blood transfusion 10 ml/kg and then give crystalloid IV fluids at the rate of10ml/kg/hr.
• In case of severe bleeding, give fresh blood transfusion about 20 ml/kg for two hours. Then give crystalloid at 10 ml/kg/hr for a short time (30-60 minutes) and later reduce the speed.
• In case of shock, give oxygen.
• For correction of acidosis (sign: deep breathing), use sodium bicarbonate.
WHAT NOT TO DO
• Do not give Aspirin or Brufen for treatment of fever.
• Avoid giving intravenous therapy before there is evidence of haemorrhage and bleeding.
• Avoid giving blood transfusion unless indicated, reduction in haematocrit or severe bleeding.
• Avoid giving steroids. They do not show any benefit.
• Do not use antibiotics.
• Do not changes the speed of fluid rapidly, i.e., avoid rapidly increasing or rapidly slowing the speed of fluids.
• Insertion of nasogastric tube to determine concealed bleeding or to stop bleeding (by cold lavage) is not recommended since it is hazardous.
SIGN OF RECOVERY
• Stable pulse, blood pressure and breathing rate
• Normal temperature
• No evidence of external or internal bleeding
• Return of appetite
• No vomiting
• Good urine output
• Stable... [continues]
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