I spent the best part of the days today in Putrajaya being immersed into the new Dengue treatment guideline. Certainly there is a fight shift in the treatment algorhitm compared to the last guideline from 2009.
It creator looked neat on paper, easy to follow but my main worry was the input mainly came from the Government Doctors and I worry that they may not under stand limitation of these guideline in the private setting. The practice guideline which they talked about was more on the clinical part, and as a hospital maybe SJMC may need to modify some of the nursing pathways to accommodate. Patient placement in the ward is one of the issues, as the paying customers were more keen on the size of their rooms rather than the monitoring level which the nurses could provide.
The fluid resuscitation regime appeared more systematic, with emphasis on oral fluid intake. Criteria of admission may not apply to Subang as most of time patients were admitted on their request. I was about to ask about whether the Private hospital can be more selective on their admission but that was going to be thorny issue.
I was not able to attebd tomorrow's chapter I was afraid since I would be having clinic. The topic tomorrow appeared more ICU and inpatient orientated, which was more relevant to my practice. Clearly plenty to catch although my current practice did not differ much from the gist of the discussion. At least the need for platelet transfusion was laid out as I still think that there is too much pressure to transfuse either from lack of knowledge, fear if impending deterioration as well as pressure from patients and their relatives. I felt that we a plus have a poster at the Casualty spelling out that platelet transfusion does not cure dengue. The recent drama about papaya leaf also did not help matters.
On the whole, a fruitful day.
