 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
 |
 |
|
|
|
 |
|
|
|
|
|
From the Pediatric Critical Care Network
University of Puerto Rico School of Medicine, San Jorge Children's Hospital and Hospital Interamericano de Medicina Avanzada
|
|
|
|
|
|
|
|
|
|
Grupo Intensivo Pediatrico de San Juan,C.S.P.
Pediatric Critical Care Program
Department of Pediatrics, U.P.R.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Critical points in management
Currently, Puerto Rico is having an outbreak of Dengue Fever (DF) and several deaths have been reported. An increasing number of cases requires close monitoring due to risk of complications. This outline review several critical points in the basic evaluation and management of children having Dengue. DF is an acute illness characterized by fever, retro-orbital headache, severe myalgia, and occasionally a rash, lasting from 5 to 7 days. During seasonal periods of Dengue in Puerto Rico (July to November), any infant or child presenting with fever and such other symptoms should be evaluated for Dengue. Those cases should be thoroughly examined and closely followed with vital signs. Complete blood cell count (CBC) and initial Dengue antibody titers should be taken.
A small percentage of patients with Dengue may progress to more severe forms of the disease, with hemorrhagic manifestations and/or shock. The World Health Organization defines Dengue Hemorrhagic Fever (DHF) when Dengue illness is accompanied by positive tourniquet test, thrombocytopenia (less than 100,000/mm3) and hemoconcentration
|
|
|
|
|
|
|
|
|
|
|
(hematocrit >20% above baseline value. Dengue Shock Syndrome (DSS) is diagnosed when hypoperfusion signs accompany these manifestations. For the pediatric age group you may use the following formula (Dallman, 1979): Baseline hemoglobin = 11.0 + age (yr.) up to 10 years of age expressed in decimals. For example, the expected hemoglobin for an 8 year-old is 11.8 gm. The hematocrit may be considered to be three (3) times the hemoglobin value.
The major pathophysiologic mechanism in DHF and DSS is increased vascular permeability causing plasma leakage and third space formation. Therefore, hemoconcentration is the best predictor that capillary leaks and volume depletion is occurring. Uncorrected hypovolemia will lead to circulatory failure and organ dysfunction, including bleeding and death.
Evidence should be gathered for bleeding abnormalities and third space formation such as the presence of pleural effusion. A chest right lateral-decubitus film may be used to diagnose early effusion.
(Continued on page 2)
|
|
|
|
|
|
|
|
|
|
 |
|
|
|
|
|
|
|
|
Welcome to the Pediatric Critical Care Newsletter From The Editorial Board
|
|
|
|
|
|
|
|
|
|
|
|
Since 1976 the Pediatric Intensive Care Unit at the University Pediatric Hospital gives care to critically ill children. This Unit has the only accredited training program in Pediatric Critical Care in Puerto Rico. It is the main training facility for such subspecialty to pediatricians, other related medical specialties and allied health personnel.
Recently, multi-center private corporations opened their own Pediatric Intensive Care Units. With that trend and the implantation of the Health Care Reform in Puerto Rico a
|
|
|
|
|
|
|
|
|
|
|
"Network" of specialized Units were developed. That "Network" assures access to excellent care to any child, either covered under the government plan or under the major private health insurance companies. To maintain and expand the highest quality of care in a cost-effective way we need a forum to share ideas and disseminate interesting topics in the field of Pediatric Critical Care and it's related specialties. The Pediatric Critical Care Newsletter® will be that forum to fulfill our goals. This can only be achieve if we have the assistance of our readers and collaborators.
|
|
|
|
|
|
|
|
|
 |