HISTORY TAKING OF FEVER

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

Continuous fever (typhoid)Continuous fever (typhoid)

Febris remittent

37

38

39

Intermitent fever (Malaria)Intermitent fever (Malaria)

Relapsing feverRelapsing fever

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

Rumpeleede / Torniquete test

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)

ResultResult