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Fever in ER

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Dr Vinay Patil    20 January 2017

Japanese encephalitis - Supportive treatment: airway management, seizure control and management of raised intracranial pressure. Enteric fever - First-line: Ceftriaxone for 10-14 days to cover MDR S. typhi; azithromycin and ciprofloxacin are alternatives; consider dexamethasone 3 mg/kg followed by 1 mg/kg 6 hourly for 48 hours in selected cases with encephalopathy, hypotension or DIC. Fever with respiratory distress: Antipyretics; IV fluids; oxygen by Venturi mask; injection ceftriaxone 100 mg/kg/day IV in 2 divided doses; injection azithromycin 15 mg/kg/day IV OD; tablet oseltamivir 3 mg/kg BD, if H1N1 is a possibility. Fever with renal failure: Antipyretics; injection ceftriaxone 100 mg/kg/day IV in 2 divided doses; tablet doxycycline 100 mg BD; IV fluids; renal replacement therapy (intermittent HD/CRRT). Fever with jaundice: Antipyretics; injection ceftriaxone 100 mg/kg/day IV in 2 divided doses; tablet doxycycline 100 mg BD; IV fluids; FFP/cryoprecipitate for bleeding. Fever with thrombocytopenia: Antipyretics; IV fluids; avoid aspirin/anticoagulants; platelet transfusion if platelet count <20,000 or clinical bleeding; no role of steroids. Keep syndromic approach. Follow evidence-based algorithms. Choose reliable rapid diagnostic modalities. Start early empiric therapy based on clinical syndromes. Keep update about infections prevalent in your region. Early referral to tertiary care unit in stable condition, if working in periphery.

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