This thermometer illustrates the developments in the illness
that are progressive warning signs that DSS may occur.
- The initial evaluation is made by determining how many
days have passed since the onset of symptoms. Most patients
who develop DSS do so 3-6 days after onset of symptoms.
Therefore, if a patient is seven days into the illness,
it is likely that the worst is over.
- If the fever goes between three and six days after the
symptoms began, this is a warning signal that the patient
must be closely observed, as shock often occurs at or around
the disappearance of fever. Other early warning signs to
be alert for include a drop in platelets, an increase in
hematocrit, or other signs of plasma leakage.
- If you document hemoconcentration and thrombocytopenia
and other signs of DHF and the patient meets the criteria
for DHF, the prognosis and the patient's risk category have
changed. Though dengue fever does not often cause fatalities,
a greater proportion of DHF cases are fatal.
- The next concern would be observation of the danger signssevere
abdominal pain, change in mental status, vomiting and abrupt
change from fever to hypothermia. These often herald the
onset of DSS.
- The goal of treatment is to prevent shock. The plasma
leakage syndrome is self-limited. If you can support the
patient through the plasma leakage phase and provide sufficient
fluids to prevent shock, the illness will resolve itself.
|