FN: Meningitis Flashcards
Features
Meningitic
Neurological
Septic
Meningitic
HEadache
Neck stiffness
Photophobia
n/v
Neck stiffness signs
Kernigs
Brudzinskis
Kernigs
Straightening leg with hip @ 90degrees
Brudzinski’s
Lifting head –> lifting of legs
Neurological
reduced GCS - coma
Seizures (20%)
Focal neuro (20%) e.g. CN palsies
Septic
Fever low BP, high HR Raised CRT purpuric rash DIC
Abx therapy
- Community: benpen 1.2g IV/IM
- 50 ceftriaxone + ampicillin 2g IVI/4h
- If viral syspected: aciclovir
Organisms
- viruses: enteroviruses (Coxsackie, echovirus), HSV2
- Meningococcus
- Pneumococcus
- Listeria
- Haemophilus
- TB
- Cryptococcus
Investigations
Bloods: FBC, U+E, clotting, glucose, ABG
Blood cultures
LP: MCS, glucose, virology/PCR, lactate
Acute Management
Step 1
ABC
- Oxygen 15L - SpO2 94-98%
- IVI fluid resus with crystalloid
distinguish between septicamic or Meningitis
Mainly septicaemic treat with
- Dont attempt LP
- Ceftriaxone 2g IVI
- Consdier ITU if shocker
Mainly Meningitis
- If no shock or CIs do LP
- Dexamethasone 0.15mg/kg IV QDS
- Ceftiaxone 2g IVI post-LP
Prophylaxis for nearby people
Rifampicin
Contraindications for an LP:
Try LP Unless ContraINdicated
Thrombocytopenia LAteness (delay in antibiotic admin) Pressure (Cardio + resp systems) Unstable (Cardio + resp systems) Coagulation disorder Infection at LP site Neurology (focal neurological signs)
Findings in CSF for Bacterial
Apperance: Turbid
Cells: PMN
Count: 100-1000
Glucose: low (1.5)
CSF findings in TB meningitis
Apperance: fibrin web
Cells: Lympho/mononuc
Count: 10-1000
Glucose: low (
CSF findings in Viral
AppearanceL Clear Cells: Lympho/mononuc Count: 50-1000 Glucose:>1/2 plasma Protein mild
