Last Updated on February 10, 2023
Warning signs
• Lethargy, restlessness
• Abdominal pain — abdominal tenderness & continuous pain
• Clinical fluid accumulation — pleural effusion / ascites
• Liver enlargement >2 cm
• Persistent vomiting
• Mucosal bleed
• Laboratory findings: ↑ haematocrit with concurrent ↓ platelet
Severity of shock
Normal Circulation | Compensated Shock | Decompensated / Hypotensive Shock | |
Consciousness level | Clear & alert | Clear (may be missed if you do not touch patient) | Change of mental state - restless / drowsy |
Temperature of extremities | Warm & pink | Cold | Cold clammy extremities |
Capillary refill time (CRT) | Brisk (<2 seconds) | Prolonged (>2 seconds) | Mottled skin, very prolonged CRT |
Peripheral pulse volume | Good volume | Weak & thready pulses | Feeble / Absent |
Heart rate | Normal | Tachycardia | Severe tachycardia // bradycardia in late shock |
Blood pressure | Normal | - Normal SBP with rising DBP - Postural hypotension | Hypotension / Unrecordable BP |
Pulse pressure | Normal | Narrowing pulse pressure | Narrowed (≤20 mmHg) / Unrecordable |
Respiratory rate | Normal | Tachypnoea | Metabolic acidosis / Hypernoea |
Urine output | Normal | Reducing trend | Oliguria / Anuria |
CPG
CPG Management of Dengue in Children (2nd ed, 2020)
Take Home Message
1. Child must be touch touched, or else parameters of shock will be missed e.g. cold extremities, weak peripheral pulses, prolonged CRT