M13 - Meningococcal Septicaemia

Question 1

Meningococcal disease is a ____ ____ illness requiring ____ ____. In the early phase the symptoms may include ____, ____, ____, ____ and _____, making it difficult to distinguish from a ____, ___-____ illness.

Whilst most patients will develop a ____, it may be difficult to detect as it may start with a ____ ____ ___ and then become a ____ (_____) ___-____ ____. A ____ may be scant or even absent.

Answer 1

Rapidly evolving, urgent treatment.
Fever, nausea, vomiting, malaise, lethargy; milder, self-limiting.
Rash, blanching pink rash, purpuric (haemorrhagic) non-blanching rash.
Rash

Question 2

Common signs/symptoms may include (5)

Answer 2

• Fever or rigours
• Irritability and lethargy
• Headache
• Poor appetite
• Nausea & vomiting

Question 3

Can be associated with (14)

Answer 3

• Limb/joint pain
• Neck stiffness
• Severe headache
• Seizures (late sign)
• Tachycardia
• Hypotension
• Oliguria/thirst
• Rash anywhere on the body
• Abdominal pain (sometimes with diarrhoea)
• Pale/mottled/blue skin
• Drowsiness/confusion/impaired LOC
• Focal neurological deficit
• Cold hands and feet and prolonged CRT
• Tachypnoea, laboured breathing, hypoxia

Question 4

What can be life saving in suspected meningococcal septicaemia?

Answer 4

Early administration of antibiotics

Question 5

___ or ____ extremities and ____ in the presence of ____ are key signs of the onset of ___ ___. In ____ ____ ____, ____ may be absent and _____ may be present.

Answer 5

Cold, cyanotic, pallor, fever, septic shock.

Severe septic shock, fever, hypothermia

Question 6

Treatment:
1. ___ ___ (__) - it is imperative to identify the presence of ___ ____ or other symptoms or history indicative of ____ ____.
2. Medication: ____ ____ ___ (___) - if signs of _____
3. Does Pt have ___-____ ___ and/or ___/___ ___ (___)
No: Continue to _____ Pt for presence of ____
Yes: Medication: ____ ____ (___)
4. Treat associated conditions (if indicated) x3
5. If yes to 3: ____ ___ (__) with ___ __ or if no: ____
6. Regularly repeat and document ____ ____ ___ and ___ ___ in order to identify trends in ____ ____
7. On arrival at ED, provide a ____ _______ ____ ____ including advice that the patient has ____ ____ signs and symptoms, including a ___ ___ ___ ___.
PPE: ___ ___ should be applied if there is suspicion of meningococcal disease.

Answer 6

1. Patient care (A2), any rash, meningococcal septicaemia
2. Compound sodium lactate (211), hypovolaemia
3. Non-blanching rash; red/yellow criteria (R28); reassess, rash; Benzyl penicillin (226)
4. Seizures (M9); Nausea and vomiting (M6), Dehydration (M8)
5. Urgent transport (A8), Code 3; transport
6. ABCD physical examinations, physiological observations, clinical deterioration
7. Comprehensive IMISTAMBO clinical handover; meningococcal septicaemia; Septic Shock Advisory Care
   Droplet precautions

Question 7

Medication for meningococcal septicaemia if signs of hypovolaemia
Medication, ages, route, dose, repeats, max

Answer 7

Compound sodium lactate (211)
All ages
Route: IV
Dose: 20mL/kg bolus
Repeats: whilst indicated
Max: none.

Question 8

Medication for meningococcal septicaemia for patients with non-blanching rash and/or red/yellow criteria (R28):
Medication, route, ages, dose, repeats, max.

Answer 8

Benzyl penicillin (226)

IV/IO: dissolve 600mg in 10mL NaCl
<1yo - 300mg (5mL), no repeat, one dose max.
1-9yo - 600mg (10mL), no repeat, one dose max.
>=10yo - 1200mg (20mL), no repeat, one dose max.

IM: dissolve 600mg in 2mL NaCl
<1yo - 300mg (1mL), no repeat, one dose max.
1-9yo - 600mg (2mL), no repeat, one dose max.
>=10yo - 1200mg (4mL), no repeat, one dose max.