Name :
Sex
R/N
Weight :
kg
Height :
cm
Age :
I/C
DENGUE CARE CHART
DEPARTMENT
HOSPITAL
Ward:
ALERT SENIOR IF IN RED
CATEGORIES (SEE KEY BESIDE)
Date
180
180
160
160
160
140
140
140
120
120
120
Systolic BP
100
100
100
Diastolic BP
80
80
80
60
60
60
40
40
40
IgM
Pos / Neg
IgG
Pos / Neg
NS1 Pos / Neg
mmHg
Pulse Rate
bpm
N U R S E
if 50 please INFORM DR
50
50
40
40
40
30
30
30
20
20
20
10
10
10
Pulse Pressure X
if <20 please INFORM DR
Respiratory Rate
if >24 please INFORM DR .
if >24 DR to do ABG
SpO2
I N
50
CRT
Temperature of extremities
Bleeding
T O
Abdominal pain
Vomiting
D O C T O R
Hct
(Male >45% Female >40%)
Hb
Plt
WCC
ALT
HCO3 (Actual)
Key : CRT: I (immediate); <2s; 2s
F I L L
Pulse volume
Pulse volume: N(normal); W(weak); A(absent)
Temperature of extremities: W (warm); C (cold)
T O
F I L L
I N
Non-invasive BP
Abdominal pain: + / Vomiting: No or Yes (number of times/day)
180
Bleeding: P(provoked); S(Spontaneous) + M(mucosal; C(cutaneous)
Time
Immunology Date
Taken:
_______________
(please circle):