Meningitis Flashcards
Signs if meningism
Nuchal rigidity or neck stiffness
Photophobia
Vomiting
Kernig’s +ve
Brudzinski +ve
Complications of meningtiis
Hearing loss
Seizures and epilepsy
Cognitive impairment and learning disability
Memory loss
Focal neurological deficitssuch as limb weakness or spasticity
Management of meningitis
A to E
Fluid resuscitation
Antibiotics according to trust policy
Often cover treat and also cover for viral causes (viral encephalitis) whilst waiting for the LP results
What antibiotics are used in meningitis
Ceftriaxone IV 2g stat, then 2g 12 hourly
If >50 years, alcoholic, debilitating disease, or impaired immunity, consider adding IV amoxicillin
Consider IV Dexamethasone
Tx as per culture results if bacterial
Most commonly Neisseria meningitidis or Streptococcus pneumoniae in adults
Meningitis investigations
Bloods
LP
CT head if worried about subarrach
What is it importnat to do with meningitis?
Track close contacts
What is it importnat to do with meningitis?
Track close contacts
Non blanching rashes
Petechial rash - less than 2mm
Purpuric rash - haemarrhagic - over 2mm
What test is for non blanching rash?
Glass test
Where to check on darker skin for meningococcal rash?
Paler areas of the body eg soles of feet or palms og hands, conjuctivae or palate
Can a non blanching rash still be a sign of meningitis?
Yes - blanching can -> non blanching rash as illness progresses
What does a rapidly developing petechial or purpuric rash suggest?
Sign of v severe disease
Risk stratification when suspect meningitis or meningococcal disease
Conscious level - GCS, AVPU
HR + BP
RR, 02 sats
Temp
Cap refill
Features of shock in meningococcal disease
Cap refill time over 2 s
Unusual skin colour
Tachycardia and/or hypotension
Resp symptoms or breathing difficulty
Leg pain
Toxic/moribund state
Altered mental state/decreased
Poor urine output
History suggestive of meningitis
New altered mental state
Acute deterioration of functional ability
Immunocompromised
Trauma, surgery, invasive procedures last 6 weeks
