Manual for completing the protocol forfebrile patients
Clinical data regarding the current disease
Symptoms
1. Fever
Do you check fever with a thermometer?Which was the highest temperaturechecked?
If the answer is positive, classify fever based on the highest temperaturechecked into the categories below.If the answer is negative, check “Notmeasured” (4).
0 – No fever.
1 – 37.0-37.5 oC
2 – 37.5-38.5 oC
3 – >38.5 oC
4 – Not measured (missing value).
2.Chills
“Do you have chills?” Do you need to warm yourself to feel better?
or
“Do you feel cold and get goose bumps?”
0 – No.
1 – Yes, temporary chills, with no need for a coat.
2 – Yes, chills that make the patient look for symptom relief.
3 – Yes, chills that do not get better with relieffactors (use of a coat).
3.Headache
“Do you have headaches?” If yes, do you need painkillers? Did you get relief?
0 – No
1 – Yes, but the patient does not need to look for symptom relief.
2 – Yes, but the patient getspartial or total relief from medications.
3 – Yes, persistent headache that does not get better with theuseof medications.
4.Photophobia
“Does light bother you?” Do you try to avoid it?
0 – No
1 – Yes, slightly, but it does not impair the patient’sactivities.
2 – Yes,but the patientcan tolerate it with the use ofrelief factors (sun glasses, etc).
3 – Yes, very much, and the patientneeds to avoid any light (to be in a dark room).
5.Retrorbital pain
“Do you feel pain in your eyes or around them?”(Show the patient the area)
If yes:Does it get better with medication?
0 – No
1 – Yes, but the patient doesnot need to look for symptomatic relief.
2 – Yes, but partial or total relief is obtained with the use of medications.
3 – Yes, constantly, and it does not get better with the use of medications.
6.Oropharyngeal pain:
“Does your throat ache during food, water or saliva ingestion?” Is it relieved with medication?
0 – No
1 – Yes, but the patient does not need to look for symptomatic relief.
2 – Yes, but partial or total relief is obtained with the use of medications.
3 – Yes, constantly, and it does not get better with the use of medications.
7.Hoarseness
“Have you noticed any change in your voice? Do you have a hoarse voice?”
0 – No
1 – Yes, but it does not bother the patient.
2 – Yes, the patient needs to make an effort to speak.
3 – Yes, it is incapacitating (aphonic).
8.Taste change
“Does food or water taste differently?”(Y/N)
9.Earache
“Do you have earache?” Do you get relief frommedication?
0 – No
1 – Yes, but the patient does not need to look for symptom relief.
2 – Yes, but the patient gets partial or total relief from medications.
3 – Yes, persistent earache that does not get better with the useof medications.
10.Coryza
“Do you get a runny nose?” (Y/N)
11.Nasal congestion
“Does your nose get stuffy?”(Y/N)
12.Exhaustion
“Do you feel tired? Have you been exhausted?”
0 – No
1 – Yes, but the patient can perform daily chores.
2 – Yes, and exhaustion limits the patient’s daily chores.
3 – Yes, and the patient cannot perform any daily chore (rests all day long).
13.Myalgia
“Does your body ache?” Does it get better with medication?
0 – No
1 – Yes, but the patient does not need to look for symptomatic relief.
2 – Yes, but partial or total relief is obtained with the use of medications.
3 – Yes, constantly, and it does not get better with the use of medications.
14.Lumbar back pain:
“Do you have lumbar back pain?” (Show the patient the site referred to)
0 – No
1 – Yes, but the patient does not need to look for symptomatic relief.
2 – Yes, but partial or total relief is obtained with the use of medications.
3 – Yes, constantly, and it does not get better with the use of medications.
15.Arthralgia
“Do your joints ache?”(Exemplify by showing the patient some body joints)
0 – No
1 – Yes, but the patient does not need to look for symptomatic relief.
2 – Yes, but partial or total relief is obtained with the use of medications.
3 – Yes, constantly, and it does not get better with the use of medications.
16.Anorexia
“Have you lost your appetite?”
0 – No
1 – Yes, but the patient eats all his/her usual meals.
2 – Yes, and the patient refuses most foods.
3 – Yes, and the patient refuses any food.
17. Nauseas
“Do you feel nauseous?”
0 – No
1 – Yes, occasionally, but the patient does not look for symptomatic relief.
2 – Yes, but relief is obtained with the use of medications.
3 – Yes, constantly, and it does not get better with the use of medications.
18. Vomiting
“Have you thrown up?”
0 – No
1 – Yes, a small amount and only after theingestionof solid food.
2 – Yes, after the ingestion of solid or liquid food, and relief is obtained with the use of medications.
3 – Yes, constantly even with no oral ingestion, and it does not get better with the use of medication(unstoppable).
19.Abdominal pain
“Does your stomach ache?”
0 – No
1 – Yes, but the patient does not need to look for symptom relief.
2 – Yes, but the patient gets partial or total relief from the useof medications.
3 – Yes, constantly and it does not get better with the useof medications.
20.Choluria
“What color is your urine? Is its color similar to that of ‘Coca-Cola’™?” (Y/N)
21. Diarrhea
“Do you have diarrhea?(Y/N)
22.Dyspnea
Ask the patient about difficulties in breathing, relating them to physical activities to determine their intensity.
“Do you have shortness of breath?”
0 – No
1 – Yes, on heavyexertion (stair climbing, walking uphill)
2 – Yes, onmoderate exertion (walking on the level)
3 – Yes, on light exertion (bathing, hair combing)or at rest
Cough(presence and characteristics)
“Have you been coughing?”Is the cough dry or productive?
According to the answer, quantify as follows:
23. Dry cough
0 – No
1 – Yes, sporadic.
2 – Yes, the patient reports coughing all day long, but that does not interfere with his/her daily activities
3–Yes, accompanied by shortness of breath, interfering with sleep or daily activities.
24.Productive cough(presence and type of secretion)
“Is your cough accompanied by expectoration?What color is the expectoration/sputum?
Clear (mucoid)? Yellow orgreenish?”
0 – No
1 – Yes, with little secretion.
2 – Yes, with amoderateto large amount of clear secretion.
3 – Yes, with a moderate to large amount of mucopurulent secretion (yellow orgreenish).
25.Hemorrhage(Y/N)
“Do you have any abnormal bleeding?”
Ask for specific bleeding sites. If the answer is affirmativeto any of the following questions, check Yes for Hemorrhage.
25.1.Epistaxis
“Have you had a nosebleed?”
0 – No.
1 –Yes, a small amount, andit stopped spontaneously in up to 10 minutes.
2 – Yes, a persistent bleeding for more than 10minutes and less than one hour.
3 – Yes, persistent and continuous for more than one hour.
25.2. Gingival hemorrhage
“Have you had gingival bleeding since the beginning of the current disease? Was it spontaneous or during toothbrushing? Is it an old problem (chronic) or has it appeared during the current disease?(Do not consider if the pattern is identical to that prior to the current disease)
0 – No.
1 – Yes, sporadically during toothbrushing.
2 – Yes, frequently during toothbrushing.
3 – Yes, thegingiva bleeds spontaneously.
25.3. Metrorrhagia
“Have you had vaginalbleeding outside the menstrual period? Was the volume smaller or larger than, or equal to that of the usual menstruation?”
0 – No
1 – Yes, a small volume, much smaller than that of the usual menstruation.
2 –Yes, similar in volume to that of the usual menstruation.
3 – Yes, larger volume than that of the usual menstruation.
25.4. Hematuria
“Have you noticed your urine turn red?Have you urinated blood?”
0 – No.
1 – Yes, the patient noticed achange in urine color tored.
2 – Yes, the patient reported eliminating deep red urine.
3 – Yes, the patient eliminated bright red blood through the urethra (urethrorrhagia).
25.5. Hematemesis
“Have you vomited blood? Have you had blackvomits, or vomit like coffee grounds?”
0 –No.
1 – Yes, a small volume(streaks of blood in the vomit).
2 – Yes, a moderate volume.
3 – Yes, the patient reported bright red blood vomit orvomit like coffee grounds.
25.6. Melena
“What color are your stools? Are your stools dark-colored, non-solid, and strongly bad smelling?”(Y/N)
25.7. Hemoptoic episodes/Hemoptysis
“Have you had a blood expectoration?Have you coughed bright red blood? How many times has that occurred since the beginning of the current disease?”
0 – No.
1 – Yes, sporadic eliminationof streaks of blood in thesputum.
2 – Yes, frequent expectoration of blood (three or more times a day).
3 –Yes, eliminationof bright red blood after coughing(hemoptysis).
26.Dizziness
“Have you felt dizzy andfaint?”
0 – No
1 – Yes, the patient reported one isolated episode that lasted a few seconds.
2 – Yes, the patient reported several episodes.
3 – Yes, the patient reported an episode lasting some minutes,accompanied by nausea, loss of lower limb strength, visual orhearingalterations, and sweating.
27. Exanthem
“Have you noticed the presence of pinkish or reddish spotsin your skin?Are they isolated orscattered throughout the entire body ‘gathering’into larger spots?”
0 – No.
1 – Yes, in a part of the body.
2 – Yes, throughout the body, sparing only the face.
3 – Yes, throughout the body, with coalescent areas.
28.Pruritus
“Have you experienced generalized itching or itching in any partof your body?”
0 – No.
1 – Yes, isolatedoutbreaks, which do not interferewith the patient’s activities or sleep.
2 – Yes, all day long, making the patient look for symptomatic relief.
3 – Yes, constantly, interfering with the patient’s sleep and/or causing severe skin irritationand scarification.
Physical Examination
Measure and record axillary temperature, heart and respiratory rates, and blood pressurein the seating and lying down positions
1. Hypotension (Y/N)
Is systolic BP lower than 90 mmHg?
2.Delayed capillary refill (Y/N)
Is capillary refill time ≥ 2 sec?
3.Filiform/weak pulse (Y/N)
Check radial pulse volume. Is it weak?
4.Cold extremities(Y/N)
5.Dyspnea (labored breathing)
0 – Absent.
1 –Mild dyspnea when walking or talking.
2 – Use of accessory muscles, intercostal indrawing at rest.
3 – Evidentrespiratory distress at rest.
6.Dehydration
Assess the mucosae regarding their appearance and humidity. Turgor is checked by pinching the skin.
0– Absent.
1–Mildly dryoral mucosa, with saliva reduction.
2–Opaque, dry oralmucosa andconjunctivas.
3–Very dry mucosae, reduced skin turgor,and impaired general state of health.
7.Cutaneous andmucosal paleness
Check the color of the tongue, conjunctivas, and palmof the hands
0 – Absent.
1 –Mild discoloration of the skin and/or mucosae.
2 – Moderatediscoloration of the skin and/or mucosae.
3 –Intense paleness, with loss of the pink colorationof theconjunctivas (white or yellowish).
8.Edemas
To assess its intensity, compress the edematous area with the thumb or index fingertip and observe the indentation formed.
0 – Absent.
1 – Limited to the lower limbs, low intensity(formation of a small indentation that rapidly disappears).
2 – Limited to the lower limbs, high intensity (formation of a deepindentationthat slowly disappears).
3– Generalizededema.
9.Eye congestion/conjunctival hyperemia
Check the color and vessels of the conjunctiva.Red eyes and/or visibleeye vessels?(Y/N)
10.Jaundice
0 – Absent
1 – Yellowish color evident only in the sclera.
2 – Yellowish color evident in boththe sclera and skin.
3 – Intense yellowish colorvery evident in the mucosaeand skin.
11.Exanthem
Assess the presence and distributionof erythematous lesions and then classify thelesiontype.
0 – Absent.
1 – Yes, in part of the body.
2 – Yes, throughout the entire body or except the face.
3 – Yes, throughout the entire body, with coalescent areas.
#Macular (Y/N)
# Maculopapular (Y/N)
# Vesicular(Y/N)
12.Enanthem(Y/N)
Presence of red spots in the oropharyngeal mucosa.
13.Oropharyngeal hyperemia (Y/N)
14.Enlarged lymph nodes
0 – Absent.
1 – Restricted to onechain, lymph nodes of 1 to 2cm.
2 – Restricted to one chain, lymph nodes larger than 2cm.
3 – Lymph nodes larger than 1cm in three or more chains.
# Reportthe lymph node chains
1-cervical
2-occipital
3-supraclavicular
4-axillary
5-epitrochlear
6-inguinal
15. Petechiae
Small red or purple dots in the skin or mucosaethat do not disappearuponpressing with fingers.
0 –Absent.
1 – Small number in a mucosa orone single limb.
2 – Present in two limbs.
3 – Present in more than two limbs or disseminated throughout thebody.
16.Purpura
Erythematous or purplemaculae indicating subcutaneous bleeding. They do not disappearuponpressing with fingers.
0 –Absent.
1 –Small number, sparse,in one single limb.
2 –Present in two limbs.
3 – Present in more than two limbs or disseminated throughout the body.
17.Gingival hemorrhage
0 –Absent.
1 –Spontaneous, small, and self-limited bleeding.
2 –Spontaneous, small, andpersistent bleeding.
3 –Spontaneous, moderate bleeding (the patient “spits”blood).
18.Hepatomegaly (Y/N)
Yes,if liver measure exceeds12cm.
19.Splenomegaly
Palpatethe abdomenwith the patient in the dorsal decubitus and lateraldecubitus.
0 –Absent.
1 –Spleen palpable beneath the left costal margin with the patient in the right lateral decubitus position.
2 –Spleen palpable below the costal margin.
3 – Spleen palpable below the navel.
20. Lumbar percussion pain (Y/N) (unilateral)
Does the patient have signs oflumbar percussion pain? Do not consider if pain is bilateral and symmetrical.
21.Neck stiffness (Y/N)
With the patient in the dorsal decubitus position,flex his/her neck. Is there resistanceand pain?
Performpulmonaryauscultation and record the presence of the following:
22.Crackles (Y/N)
23.Sibilant rales
0 – Absent.
1 – Unilateral, localized.
2 – Unilateral, diffuse.
3 – Bilaterally audible.
24.Rhonchii
0 – Absent.
1 – Unilateral, localized.
2 – Unilateral, diffuse.
3 – Bilaterally audible.
25.Heart murmur
0 – Absent.
1 – Mild, localized.
2 – Audible throughout the precordium, without fremitus.
3 – Intense murmur, with fremitus.