What are the key management steps for multiple dengue patients tonight?

Management of Multiple Dengue Patients During Night Shift

For effective management of multiple dengue patients tonight, implement systematic monitoring for warning signs, ensure adequate fluid management, and avoid NSAIDs for pain control. 1, 2

Initial Assessment and Monitoring

• Perform daily complete blood count monitoring for all patients to track platelet counts and hematocrit levels 1, 2
• Monitor vital signs regularly, with special attention to blood pressure, pulse pressure, and signs of shock 2
• Check for warning signs of severe dengue including:
  • Persistent vomiting and severe abdominal pain 1, 2
  • Lethargy or restlessness 2
  • Mucosal bleeding 2
  • Rising hematocrit with falling platelet count 2, 3

Fluid Management

• For patients without shock:
  • Ensure adequate oral hydration with more than 2500ml daily 1, 2
  • Use oral rehydration solutions for those with moderate dehydration 2
• For patients with signs of dengue shock syndrome:
  • Administer an initial fluid bolus of 20 mL/kg crystalloid with careful reassessment afterward 1, 2
  • Consider using colloid solutions for severe shock when available 2
  • Avoid excessive fluid boluses in patients without shock as this can lead to fluid overload and respiratory complications 3

Pain and Symptom Management

• Administer acetaminophen at standard doses for pain and fever relief 1, 2
• Avoid aspirin and NSAIDs under any circumstances due to increased bleeding risk 1, 2, 4
• Ensure patients are comfortable with appropriate positioning and environmental temperature control 1

Management of Complications

• For significant bleeding, prepare for possible blood transfusion 1, 2
• For persistent tissue hypoperfusion despite adequate fluid resuscitation, consider vasopressors such as dopamine or epinephrine 1, 2
• Monitor for respiratory distress and be prepared to provide oxygen therapy if needed 1
• Watch for signs of secondary infections which may require antibiotic coverage 2

Special Considerations for Different Patient Groups

• For pregnant women with dengue fever, continue acetaminophen as the safest analgesic option 1, 2
• For children, carefully calculate acetaminophen dosing based on weight 1, 2
• Pay particular attention to fluid management in children with dengue shock syndrome 2

Documentation and Handover

• Document all interventions, fluid intake/output, and changes in clinical status 2
• Prepare clear handover notes for the day team, highlighting:
  • Patients with warning signs 2
  • Recent changes in laboratory values 2
  • Fluid management plans 1
  • Any interventions performed during your shift 2

Discharge Planning

• Identify patients who may be eligible for discharge based on:
  • Being afebrile for at least 48 hours without antipyretics 2
  • Stable hemodynamic parameters for at least 24 hours 2
  • Improving laboratory parameters 2
  • Adequate oral intake and urine output 2

Common Pitfalls to Avoid

• Do not delay fluid resuscitation in patients showing signs of shock 2, 5
• Avoid invasive procedures when possible during the acute phase of illness 3
• Do not fail to recognize the critical phase when plasma leakage can rapidly progress to shock 3, 5
• Avoid unnecessary prophylactic interventions for isolated leukopenia without clinical deterioration 3