Meningitis

HISTORY:

‍FeverHeadacheStiff neck for ‍ ‍hoursdays

‍fever, up to ‍°, over ‍ ‍hoursdays

‍headache, ‍diffuse, ‍persistentintermittent, ‍pressurethrobbing, ‍mild

‍stiff neck

‍sensitivity to light

‍confusion

‍nausea

‍vomiting

‍seizures

‍rash

‍sleepiness

‍loss of appetite

‍irritability

Treatments tried: ‍none, ‍effectiveineffective



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Head: ‍normocephalicatraumaticnormal scalprashlesion

Eyes: -R: ‍normal, -L: ‍normal, ‍

Ears: -R: ‍normal, -L: ‍normal

Nose: ‍normal

Throat: ‍normalrednessexudate

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Skin: ‍no rash

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍

Musculoskeletal: joints ‍ ‍normal, ‍no limited ROM

Neurologic: cranial nerves ‍normal, strength ‍5/5 throughout, sensation ‍normal, reflexes ‍2+ throughout, cerebellar function ‍normal, gait ‍stable

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought process ‍organized, ‍no suicidal ideation, judgment ‍good



ASSESSMENT:

‍Meningitis ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍CRP, ‍electrolytes, ‍creatinine, ‍coagulation panel, ‍blood gas ‍blood cultures

- CT scan of the head

- Lumbar puncture

- Nasopharyngeal swab for viral PCR

- Chest X-ray

- Urinalysis and culture

- IV fluids

- ‍Antibiotics

- ‍Antivirals

- ‍Corticosteroids

- ‍Acetaminophen

- ‍Ibuprofen

- ‍Antiemetics

- Admission to intensive care unit

- Referral to infectious disease specialist

- Referral to neurologist