A checklist for short febrile illness and summary of complications and feature on treatment

1. PROTOCOL FOR FEVERChecklist for FeverAcer [Type the company name] [Pick the date]<br />PROTOCOL FOR FEVER<br />Checklist for Fever<br />Check for the following symptoms<br />Fever Chills Rash<br />Sneezing Running nose Nasal block<br />Myalgia Headache Throat pain<br />Cough Chest pain Breathlessness<br />Nausea Vomiting Hemetemesis<br />Jaundice Abd pain Diarrohea<br />Dysuria Hematuria Oliguria<br />Eye pain Photophobia Neck pain<br />Check surface body temperature <br />In normal range(36.60C – 37.20C)<br />Febrile(37.20C – 41.50C)<br />Hyperthermia(>41.50C)<br />Hypothermia(<35.50C<br />[Calculate the expected raise in heart rate. Each 0C rise will increase pulse by 18 beats per minute]<br />Count heart rate for exactly one minute<br />Corresponds to 0C rise of temp Viral fever?<br />More than degree rise of temp Myocarditis?<br />Less than degree rise of fever Enteric fever?<br />Absolute bradycardia Heart block?<br />Count the respiratory rate for one min.<br />Normal range(14-20/min) Observe<br />Tachypnoea(>20/min.) Pneumonia?<br />Bradypnoea(14/min.) Encephalitis?<br />[Tachypnoea may indicate Broncho-pneumonia/ARDS <br />Record the blood pressure<br />BP Normal (95/65 to135/85 mm)<br />BP Hypotension(75-90 mm Sys) Myocarditis?<br />BP-Shock(<70mmHg Sys) Septic shock?<br />Examine the eyes for evidence of<br />Pallor Jaundice Conj Injection<br />Pupils Subconj Hghe Lateral R palsy<br />Examine the neck for evidence of<br />Myalgia Lateral movts Stiffness<br />JVP Tenderness Lymphnodes<br />Examine the mouth for evidence of<br />Pallor Jaundice Petechiae<br />Pharyngitis Gum bleed Tongue coating<br />Auscultate the heart for evidence of<br />Tachycardia Irregularity S3/S4<br />Gallop Murmurs if any Pericardial rub<br />Auscultate the chest for evidence of<br />Vesicular sound Rhonchi Crepitations <br />Tubular sounds Dullness VF & VR <br />Palpate abdomen for evidence of<br />Live Spleen kidney<br />LNodes Fluid thrill Shifting dullness<br />Examine the lower limbs for evidence of<br />Cellulitis Pyoderma Petechiae<br />Pulses V thrombosis Kerning’s sign<br />Diagnosis to be considered are<br />Viral Fever, URTI, LRTI, Dengue fever, Acute meningitis, Lobar Pneumonia, Bronchopneumonia, Urinary infection, H1N1 Influenza, Leptospirosis<br />Looking for complications<br />For any form of short febrile illness (most of them are of viral origin) look for evidence of complications. Maximum attention should be directed to the vital signs, which should be closely monitored at least in 4 hourly intervals and same entered in a note book (not in a piece of paper). In a given case investigate as needed. Do not withhold or delay investigations<br />Investigations to be planned are<br />Day 1: Nil<br />Day 2: Nil<br />Day 3: URE, Urine culture if UTI suspected.<br />Blood: Hb TC DC ESR, Platelet count<br />Liver function: ALT AST, ALP, S Bilirubin, PT INR<br />Renal function tests: Blood Urea, Serum creatinine<br />Day 4: Peripheral smear for Malarial parasiteP<br />Day 5: Dengue IgM, Weil’s Antibody, H1N1 swab<br />Treatment – General<br />Absolute bed rest: Escape from the daily burden at office or school. Catch hold of the opportunity. Test rest at home, till full recovery.Take plenty of oral fluids and fruit juices. Apply tepid sponging of the whole body with soft cloth dipped in Luke warm water. Lie in a large room with good ventilation and light breeze. Warm saline gargles / steam inhalation<br />Treatment –specific<br />Acetaminophen 500-650mg TID or SOS for fever. Mefenemic acid 250 TID or Proxyvon BID for severe body pain. Azithromycin 500mg OD X 3d if URTI, Amoxycillin 500mg TID or Levofloxacin500mg BID X 5d for LRTI, Doxy 100 OD or CP 10L 6hrly ATD if Leptospirosis, Tab Ciprofloxazin + Tinidazole or Ornidazole+ofloxacin BD X 3d if Infective diarrhoea<br />