meningitis Flashcards
how might neontes and infants present
poor feding
irritability
lethargy
vomiting
fever
investigations
lumbar puncture: allows identification of the oragnism with antibiotic susceptibility testiing, thus ensuring appropriate use of antibiotics
LP should be performed in all children with suspected meningitiss
contraindications of LP
coma/decreased level of consciousness
sgns of raised ICP
seizures
focal neurological sgns
purppuric rash
shock, cardiovascular compromise
things that are not contraindications for LP
breif tonic-clonic
drowsiness
irritability
vomiting
if LP is contraindicated
start antibiotics and consider CT instead
what tests to conduct on CSF
microscopy, culture and suscpetbilty
glucose aand protein
PCR to identfy vial and bacterial pathogens
other nvestigations
blood culture
PCR on blood
throat and rectal swabs (enterovirus testing)
FBC
C reactive protien
electrolytes
capillary/venous blood gas
coagulation studies
grroup and hold
role of cranial CT
when diagnosis is in doubt or when complications of meningitis are suspected
manaagement of suspected maningitis
empirical antibiotics
antimicrobial choice
<1 months: cefotaxime, benpen, aciclovir
> 1 month: ceftrixone and maybe add vanc
when to add vanc
if gram positive cocci are seen on gram stain
patient has known or susppected otitis meda or sinusitis
patient has been recently treated with penicillin, cephalosporin orr carbepenem
patient is too unwell to undergo LP
when to add acicilovir
when suspected herpes ssimplex
or varicella encephalitis
role of steroids
dexamethasone
controversial but may reduce neurological sequelae
fluids
patients with meningitis are at risk of hyponatraemia due to SIADH
any fluid replacement should be isotonic
obsservations
use the observation and response tool
admit
