MyCpdZw - Protocols Details

MENINGITIS

Meningitis is an inflammation of the membranes (meninges) surrounding your brain and spinal cord. The swelling from meningitis typically triggers symptoms such as headache, fever and a stiff neck

Diagnosis

Always consider in the context of headache & fever.

There may be vomiting, photophobia, neck pain/ stiffness, confusion, coma, irritability or fitting.

Look for neck stiffness & Kernig’s signs, purpura, hypotension.

Look for source of infection (contacts, otitis media, sinusitis) other viral illnesses.

Usual causes: viral, Strep. pneumonia,Haemophilus Influenzae, Neiss. Meningiditis. Crytococcus common in immunosuppressed & in HIV.

Management

1. ABC’s & resuscitation as indicated

2. Inform maedical expediently

3. Treat immediately as bacterial mengitis if diagnosis likely

4. IV access

5. FBC, U&E’s, LFT’s, CRP, Blood Culture

6. Nose, Throat & Ear swabs

7. Consider viral cultures & antibody titres,

8. LumbarPuncture – all need an LP, usually after a CT has shown no other causes for their presenting symptoms. CT usually unnecessary if: adult <60 years, not immunocompromised,no history of CNS disease, no seizures, normal level of consciousness & no focal neurology

9. IV antibiotics:

· Give early (even before LP) if unwell or delay to LP likely,

· Ceftriaxone 50 mg/kg up to 2 g IV BD if unknown source of H.influenzae suspected

PLUS

· Benzlypenicillin 60 mg/kg up to 1.8 g IV 4-hourly if Pneumonococcus or Meningococcus likely,

· Amphoteracin B 0.7 mg/kg IV for Cryptococcus.

10. Consider swabbing & treating close contacts

11. Inappropriate antibiotic can be ceased once organism & susceptibility are known

12. Consider steroid treatment: Strong support for use of IV Dexamethazone in infants & children, early use in adults acute bacterial meningitis (esp pneumococcal) probably beneficial.

CSF analysis:

Pressure 70-180 mm.

· Don’t remove CSF if pressure >350 mm,

· Increases in meningitis, tumors, absesses, haemorrhage & benign intracranial hypertension,

· Reduced in dehydration, diabetic coma & hyperventilation.

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