history taking of fever. anamnesis (auto anamnesis and/or hetero anamnesis) physical examination...
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Anamnesis (auto anamnesis and/or hetero anamnesis)
Physical Examination
Laboratory Analysis
Others Diagnostic modalities
Differential Diagnosis
Working Diagnosis
Beginning of anamnesisBeginning of anamnesis
Introduce yourself and what are you Introduce yourself and what are you about to doabout to do
Ask patient’s identity :Ask patient’s identity :NameNameOccupationOccupationDetailed birth-date, address etc.Detailed birth-date, address etc.
Establish relation, ask with empathy, Establish relation, ask with empathy, politelypolitely
Relationship with patientRelationship with patient The patient is the most important person. GIVE The patient is the most important person. GIVE
ATTENTIONATTENTION Ensure privacyEnsure privacy DO NOT write DO NOT write when patient speaks and needs when patient speaks and needs
attention.attention. Take note when he/she finished talking & before Take note when he/she finished talking & before
next questions, but only next questions, but only VERY BRIEF VERY BRIEF
Establish relation with anyone else taking care of Establish relation with anyone else taking care of patientspatients
If difficulties inc communication, consider need If difficulties inc communication, consider need for chaperone or interpreterfor chaperone or interpreter
History of Present IllnessHistory of Present Illness
The most important part of The most important part of history takinghistory taking
Use open questionsUse open questionsLet the patient talk freelyLet the patient talk freelyFocus or guide on the main Focus or guide on the main
problemproblemNot interrogativeNot interrogative
Open questionsOpen questions
DO askDO ask DON’T askDON’T ask
What is your problem today?What is your problem today? Do you have any problem today?Do you have any problem today?
Please tell me what do you feel?Please tell me what do you feel? Is it fever that you feelIs it fever that you feel
How did this fever start?How did this fever start? Did the fever start abruptly?Did the fever start abruptly?
What happens with the fever on What happens with the fever on the next day?the next day?
Did the fever continued at the next Did the fever continued at the next day?day?
History of Present IllnessHistory of Present Illness
Collected this information:Collected this information:
Onset of fever (gradual or abrupt)Onset of fever (gradual or abrupt)
Quality and intensity Quality and intensity
Timing; onset / when it startedTiming; onset / when it started
Timing.; duration / how long in days, weekTiming.; duration / how long in days, week
Timing; frequency / how many times in a weekTiming; frequency / how many times in a week
Any special event when it started / what triggers Any special event when it started / what triggers
fever (exercise, only at night time)fever (exercise, only at night time)
History of present illness History of present illness
Any other accompanying symtoms Any other accompanying symtoms (sweating, rigors etc.)(sweating, rigors etc.)
When was the last time healthy / before When was the last time healthy / before any symptoms occurredany symptoms occurred
Try to visualized mentally the type of feverTry to visualized mentally the type of fever
Add information of self care and previous Add information of self care and previous medicine taken. Did it help?medicine taken. Did it help?
Add this informationAdd this information
History of traveling, residency and History of traveling, residency and neighborhoodneighborhood
Previous fever / illnessPrevious fever / illnessOccupational historyOccupational history Immunization historyImmunization historyFamily historyFamily history
Diseases associated with feverDiseases associated with fever
Infection : viral, bacterial, fungal, Infection : viral, bacterial, fungal, parasiteparasite
Non infection : Non infection : - Malignancy- Malignancy
- Trauma- Trauma
- Auto immune - Auto immune
- Metabolic, - Metabolic, endocrineendocrine
Others : heat stroke, drug feverOthers : heat stroke, drug fever
Type of fever to be knownType of fever to be known
Onset of feverOnset of fever Type of fever (and timing)Type of fever (and timing)
Continuous fever Continuous fever Remittent feverRemittent fever Intermittent feverIntermittent fever Relapsing feverRelapsing fever
Abrupt onset, continuous feverAbrupt onset, continuous feverSaddle back (dengue)Saddle back (dengue)
00 11 22 33 44 55 6635
36
37
38
39
40
Others accompanied manifestationOthers accompanied manifestation
Chills Chills usually with quick/abrupt onset of feverusually with quick/abrupt onset of fever
Sweating Sweating related to the decrease of temperature during related to the decrease of temperature during
cessation of fevercessation of fever HeadacheHeadache
Non specific accompanying symptomsNon specific accompanying symptoms Can be specific in meningeal diseaseCan be specific in meningeal disease
DizzinessDizziness Non specific accompanying symptomsNon specific accompanying symptoms
Others accompanied manifestationOthers accompanied manifestation
Nausea & vomitingNausea & vomitingNon specific accompanying symptomsNon specific accompanying symptoms
RashRashRelated to viral feverRelated to viral fever
Ptechiae, ecchymosis, bleedingPtechiae, ecchymosis, bleedingMust be suspicious of dengueMust be suspicious of dengue
OthersOthers
After anamnesisAfter anamnesis
Closing the sessionClosing the session
Confirm if there is any other things Confirm if there is any other things patient wants to tellpatient wants to tell
Write information in medical recordWrite information in medical recordConsider your preliminary disease or Consider your preliminary disease or
deferential conclusiondeferential conclusion
After AnamnesisAfter Anamnesis
Prepare list of priorities for physical Prepare list of priorities for physical examexam
Check any records, notes from other Check any records, notes from other doctorsdoctors
Check other info: Check other info: laboratory result, ECG, Chest X-ray laboratory result, ECG, Chest X-ray
refer to the patient or notrefer to the patient or not
Physical Examination in DenguePhysical Examination in Dengue
Clinical Evaluation in Dengue FeverClinical Evaluation in Dengue FeverBlood pressure Blood pressure Evidence of bleeding in skin or other sites Evidence of bleeding in skin or other sites Hydration status Hydration status Evidence of increased vascular Evidence of increased vascular
permeability—pleural effusions, ascites permeability—pleural effusions, ascites Tourniquet test Tourniquet test
Torniquete testTorniquete test
After takeing blood pressureAfter takeing blood pressure Inflate blood pressure cuff to a point Inflate blood pressure cuff to a point
midway between systolic and diastolicmidway between systolic and diastolicHoldHold pressure for 5 minutes pressure for 5 minutesContinuous supervisionContinuous supervisionPositive test: 20 or more petechiae per 1 Positive test: 20 or more petechiae per 1
inch² (6.25 cm²) inch² (6.25 cm²)