DRABCDE meningitis

Question 1

You have been asked to assess a patient who has been
brought into the Emergency department. The nurse has expressed concern that the patient ‘does not look well’. No further history is available at present

first few steps

Answer 1

Latest observations: HR 130, BP 100/ 60, RR 30, Sats 93% on air, Temp 38.7

Patient meets PERT criteria- student should call for help.

D Washes hands, safe to approach.
R Patient is responsive but confused.

Question 2

airway assessment

Answer 2

Airway
Look
Feel
Listen
Measure
Treat

Airway is clear (patient talking).

Question 3

breathing assessment and management

Answer 3

Breathing

Look - Cyanosis. Trachea is central. Normal chest expansion.

Feel - - Symmetrical chest movement.
Listen - Clear.

Measure - RR 30, Sats 93% on air.

Treat - Administer high concentration of O2 via non-rebreathe mask (oxygen mask with reservoir bag) unless contraindicated. If choosing a fixed oxygen method student titrates accordingly (sats improve to 98% with oxygen). ABG. CXR.

Question 4

circulation assessment and management

Answer 4

Circulation

Look - Pale, JVP not visible, no oedema.

Feel - Cool peripheries, regular rapid pulse with normal volume.

Listen - Normal heart sounds.

Measure - HR 130, BP 100/ 60, cap refill 5 secs, urine output unknown, Temp 38.7. ECG.

Treat - Cannulate, bloods (FBC/ U+E/ cultures), start fluid challenge.

Question 5

disability assessment

Answer 5

Disability

AVPU

Responds to voice, BM 4.5 mmols.

Question 6

exposure assessment and management

Answer 6

Exposure - Pale/ clammy. Lying still, hemorrhagic rash to legs, stiff neck, photophobia.

Treat -

Recognises: Possible meningococcal meningitis.
Suggests: IV antibiotics (Ceftriaxone/ Cefotaxime 2gm).
Paracetamol for pyrexia.
(Chloramphenicol IV for Penicillin allergies).

Full systems examination. Write notes, look in medical notes, hand over.