HISTORY TAKING OF FEVER

1. HISTORY TAKING OF FEVER

2. Anamnesis (auto anamnesis and/or hetero anamnesis) Physical Examination Laboratory Analysis Others Diagnostic modalities Differential Diagnosis Working Diagnosis

3. Beginning of anamnesis • Introduce yourself and what are you about to do • Ask patient’s identity : • Name • Occupation • Detailed birth-date, address etc. • Establish relation, ask with empathy, politely

4. Relationship with patient • The patient is the most important person. GIVE ATTENTION • Ensure privacy • DO NOT write when patient speaks and needs attention. • Take note when he/she finished talking & before next questions, but only VERY BRIEF • Establish relation with anyone else taking care of patients • If difficulties inc communication, consider need for chaperone or interpreter

5. History of Present Illness • The most important part of history taking • Use open questions • Let the patient talk freely • Focus or guide on the main problem • Not interrogative

6. Open questions

7. History of Present Illness Collected this information: • Onset of fever (gradual or abrupt) • Quality and intensity • Timing; onset / when it started • Timing.; duration / how long in days, week • Timing; frequency / how many times in a week • Any special event when it started / what triggers fever (exercise, only at night time)

8. History of present illness • Any other accompanying symtoms (sweating, rigors etc.) • When was the last time healthy / before any symptoms occurred Try to visualized mentally the type of fever • Add information of self care and previous medicine taken. Did it help?

9. Add this information • History of traveling, residency and neighborhood • Previous fever / illness • Occupational history • Immunization history • Family history

10. Diseases associated with fever • Infection : viral, bacterial, fungal, parasite • Non infection : - Malignancy - Trauma - Auto immune - Metabolic, endocrine • Others : heat stroke, drug fever

11. Type of fever to be known • Onset of fever • Type of fever (and timing) • Continuous fever • Remittent fever • Intermittent fever • Relapsing fever

12. Abrupt onset, continuous feverSaddle back (dengue) 40 39 38 37 36 35

13. Continuous fever (typhoid)

14. 39 38 37 Febris remittent

15. Intermitent fever (Malaria)

16. Relapsing fever

17. Others accompanied manifestation • Chills • usually with quick/abrupt onset of fever • Sweating • related to the decrease of temperature during cessation of fever • Headache • Non specific accompanying symptoms • Can be specific in meningeal disease • Dizziness • Non specific accompanying symptoms

18. Others accompanied manifestation • Nausea & vomiting • Non specific accompanying symptoms • Rash • Related to viral fever • Ptechiae, ecchymosis, bleeding • Must be suspicious of dengue • Others

19. After anamnesis Closing the session • Confirm if there is any other things patient wants to tell • Write information in medical record • Consider your preliminary disease or deferential conclusion

20. After Anamnesis • Prepare list of priorities for physical exam • Check any records, notes from other doctors • Check other info: • laboratory result, ECG, Chest X-ray  refer to the patient or not

21. Rumpeleede / Torniquete test

22. Physical Examination in Dengue Clinical Evaluation in Dengue Fever • Blood pressure • Evidence of bleeding in skin or other sites • Hydration status • Evidence of increased vascular permeability—pleural effusions, ascites • Tourniquet test

23. Torniquete test • After takeing blood pressure • Inflate blood pressure cuff to a point midway between systolic and diastolic • Hold pressure for 5 minutes • Continuous supervision • Positive test: 20 or more petechiae per 1 inch² (6.25 cm²)

24. Result