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)