SCENARIO 2nd

By Group 1st
Scenario
A 10-year-old boy was taken by his father to the ER with cold body complaints
from 4 hours ago. Initially the child was thought to be cured by his parents,
because he had a fever and did not go down with fever. But the child's hands and
feet are getting colder and somewhat blue. Previously, children had a fever since
4 days ago and did not go down with fever. Fever appears suddenly high and the
child is weak. The child feels pain in both the legs and around the eyes. The day
before the body wasep, the child vomited and complained of abdominal pain.
Keywords
1. Pale body 4 hours ago
2. Fever 4 days ago and not go down with fever
3. The child gets colder and bluer
4. Child pain 2 legs and around the eyes
5. Before fever, children vomiting and abdominal pain
6. Fever appears suddenly high and the child is weak
Mind Mapping
Inggris

Learning Objective

1. Able to explain and know the pathophysiology of dengue shock syndrome,

dengue fever, and dengue fever.
2. Able to explain and find out physical examination and investigations from
dengue shock syndrome, dengue fever, and dengue fever.
3. Able to explain and find out clinical manifestations of dengue shock syndrome,
dengue fever, and dengue fever.
4. Able to explain and know the management of dengue shock syndrome
5. Able to explain and know education from dengue shock syndrome
Pathophysiology Of
Dengue Fever
Phisical and laboratory
examination of DHF
1. Phisical examination :
• Febris
• Injection konjungtiva, myalgia, artalgia
• Petekie, purpura, ekimosis
• Hepatomegali
• Sign of plasma leakage : efusi pleura, acites, edema
2. Laboratory examination
 Leukopenia, trombositopenia, hemoconcentration
 HCT > 20%
 IgG-IgM anti dengue +
Clinical Manifestation Dengue Fever
1) Degree I, which is a sudden fever of 2-7 days with clinical symptoms, with a
positive rumple leed test of positive weir and without spontaneous bleeding.

2) Degree II , in degree II, the manifestations are the same as degree I and coupled
with symptoms of spontaneous bleeding such as petechiae, ecchymosis.

3) Degree III , in degree III, the manifestation is the same as degree II and added to
the patient experiencing shock pressure or circulation failure, namely rapid and
weak pulse and hypotension.

4) Degree IV, in degree IV, the manifestation is the same as degree III and coupled
with a patient with severe shock with an indeterminate tension and an impotent
pulse.

 In third degree and fourth degree DHF is also called Dengue Shock Syndrome
(SSD)
Treatment Dengue Shock Syndrome
 Education
 Treat this as an emergency. Give oxygen 2-4 L /
minute nasally.
 Give 20 ml / kg of crystalloid solution such as
Ringer lactate / acetate as soon as possible.
 If there is no clinical improvement, repeat
crystalloid 20 ml / kgBW as soon as possible
(maximum 30 minutes) or consider giving a
maximum of 10-20ml / kg / hour of colloid 30 ml /
kg / 24 hours
 If there is no clinical improvement but the
hematocrit and hemoglobin decrease consider the
occurrence of hidden bleeding; give blood
transfusion / components
 If there is clinical improvement (capillary
filling and peripheral perfusion begins to
improve, pulse pressure widens), the
amount of fluid is reduced to 10 ml /
kgBW / hour in 2-4 hours and gradually
decreased every 4-6 hours according to
clinical and laboratory conditions.
 In many cases, intravenous fluids can
be stopped after 36-48 hours.
Remember many deaths occur because
of giving too much liquid rather than too
little.
THANK YOU