Meningitis Flashcards

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1
Q

What should be done if you suspect meningitis in primary care?

A

Arrange urgent transfer to secondary care

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2
Q

What should be done if you suspect meningitis in primary care and there is a non-blancing rash?

A

Give benzylpenicillin 1.2mg IM/IV before admitting

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3
Q

What are the differentials for meninigitis?

A
  • Malaria
  • Encephalitis
  • Septicaemia
  • Subarachnoid haemorrhage
  • Dengue
  • Tetanus
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4
Q

What are the early features of meningitis?

A
  • Headache
  • Fever
  • Leg pains
  • Cold hands and feet
  • Abnormal skin colour
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5
Q

What are the later signs of meningitis?

A
  • Meningism
  • Decreased GCS or coma
  • Seizures
  • Petechial rash
  • Shock
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6
Q

What signs of meningism may be present in meningitis?

A
  • Neck stiffness
  • Photophobia
  • Kernigs sign
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7
Q

What is Kernigs sign?

A

Pain and resistance on passive knee extension with hip fully flexed

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8
Q

What is the first step in managing meningitis?

A

ABCDE assessment, fluid resuscitation, blood glucose correction

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9
Q

What is the first question to ask yourself when managing meningitis?

A

Shocked or not?

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10
Q

What are the signs of shock in meningitis?

A
  • Prolonged CRT
  • Cold hands and feet
  • Low BP
  • Evolving rash
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11
Q

What should be done if a patient with meningitis is shocked?

A
  • Get ICU help
  • Blood cultures
  • IV antibiotics
  • Airway support
  • Fluid resus/inotropes/vasopressors
  • Delay LP until stable
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12
Q

What question should be asked if a patient with meningitis is not shocked?

A

Do they have signs of raised ICP?

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13
Q

What are the signs of raised ICP in meningitis?

A
  • Papilloedema
  • Uncontrolled seizures
  • Focal neurology
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14
Q

What should be done if a patient with meningitis has signs of raised ICP?

A
  • Get ICU help
  • IV antibodies (after cultures)
  • Dexamethasone 10mg IV
  • Airway support
  • Fluid resus
  • Delay LP until stable
  • Nurse at 30 degrees
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15
Q

What should be done if a patient with meningitis doesn’t have signs of raised ICP?

A
  • LP within 1 hour
  • IV antibodies (before LP if LP is delayed >1 hour)
  • Dexamethasone 10mg IV
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16
Q

What should be done after the acute management of meningitis?

A
  • Discuss abx with micro and adjust based on organism
  • Maintain normovolaemia
  • Isolate for 24 hours
  • Inform PHE
17
Q

What empirical antibiotics are used for meningitis?

A

Ceftriaxone 2g/12 hours

18
Q

What may be added to empirical antibiotics for meningitis?

A

Amoxicillin 2g/4 hours

19
Q

When should amoxicillin be added to empirical antibiotics for meningitis?

A

If >60 years of age or immunocompromised

20
Q

Who needs meningitis prophylaxis?

A
  • Household contacts in droplet range

- Those who have kissed patient

21
Q

What is used for meningitis prophylaxis?

A

Ciprofloxacin

22
Q

How does CSF fluid appear in bacterial, TB, and viral meningitis?

A
Bacterial = often turbid
TB = often fibrin web
Viral = often clear
23
Q

What is the predominant cell in the CSF in bacterial, TB, and viral meningitis?

A
Bacterial = polymorphs
TB = mononuclear
Viral = mononuclear
24
Q

What is the CSF cell count in bacterial, TB, and viral meningitis?

A
Bacterial = 90-1000
TB = 10-1000
Viral = 50-1000
25
Q

What is the CSF glucose in bacterial, TB, and viral meningitis?

A
Bacterial = <1/2 plasma
TB = <1/2 plasma
Viral = >1/2 plasma
26
Q

What is the CSF protein in bacterial, TB, and viral meningitis?

A
Bacterial = >1.5
TB = 1-5
Viral = <1