Emergency Presentations

Question 1

How does meningitis present?

Answer 1

• Drowsiness. floppyness, N+V, off feeds, confusion, irritability
• Photophobia
• Seizure

Question 2

What are some of the signs of paeds meningitis?

Answer 2

• Bulging fontanelle <18 months
• Neck stiffness
• +ve Kernig and brudzinkski sign
• Focal neurological signs/ papillodema

Question 3

How is meningitis investigated?

Answer 3

1. A- E
2. Bloods: FBC, UE. CRP, glucose, clotting
3. ABG
4. LOC assessment
5. LP

Question 4

What are the CI to LP?

Answer 4

• Infection at LP site
• Signs of raised ICP
• Signs of cardiorespiratory instability
• Post seizure
• Focal neurological signs
• Concerns about meningococcal septicaemia

Question 5

What is the mx of bacterial meningitis?

Answer 5

<28 days: cefotaxime, amoxicillin + gent

>28 days: cefotaxime + amoxicillin

If > 3 months steroids: dex.

Duration depends on the bacterial agent

N. meningitis - 7 days

H influenzae: 10 days

Strep pneumoniae/ GBS: 14 days

E. Coli/ listeria: 21 days

Question 6

What other treatment considerations are important for meningitis?

Answer 6

• Steroids < 3months prevents hearing loss
• IV fluids: normal saline.
• CT scan
• Hearing test within 6 weeks

Question 7

What are some of the acute and long term complications of meningitis?

Answer 7

• Acute: septic shock, DIC, Raised ICP, SIADH, hydrocephalus. cerebral abscess
• Long term: hearing loss,vasculitis, subdural effusiion, infarctiom. learning difficulties