Meningitis, bacterial/meningococcal disease
History/questionnaire: Temperature:
- Fever? - Te,mperature less than 36 degrees? Neurological:
- Altered level of consciousness or recognition (including confusion and delirium)?
- Foral neurological deficits?
- Headache?
- Neck stiffness (including more subtle discomfort or reluctance to move the neck)?
- Photophobia?
- Seizures? Appearance: - Ill appearance?
- Bulging fontanelle? - Non-blanching petechial or purpuric rash (with lesions larger than 2 mm purpura),, rapidly progressive and/or spreading?
- Pale, mottled skin or cyanosis?
Behaviour:
- Irritability?
- Lethargy (does not wake or if roused does not stay awake) ?
- Reduced feeding ? - Unusual behaviour?
- Weak, high -pitched or continuous cry?
Cardiovascular: -- Cold hands and feet? -- Heart rate < 60 beats per minute (in babies and children < 12 years)? -- High age-specific heart rate?
-- Low age-specific blood pressure? -- Capillary refill times of 3 seconds or longer? -- Reduced urine output? Respiratory:: - High age-specific respiratory rate?
- Apnoea?
- Grunting ? Other:
- Unexplained body pain, including limb, back or bdominal pain?
- Vomiting ? - Diarrhoea?
- Leg pain ?
Past medical history?
Current medication?
Known drug allergies?
Examination:
Conscious level (eg AVPU scale, Alert, responds to Voice, to Pain, Unresponsive)?
BP (mmHg)?
P (bpm)?
T (°C)?
SpO2 (%)?
CRT (seconds)?
Hydration status?
Kernig’s sign?
Brudzinski’s sign?
Management:
Category 2 ambulance called, referral letter written?
As non-blanching rash or signs of meningococcal septicaemia antibiotic given (IV or if vein not available IM as proximal as possible into a warm limb where perfusion will be better)?
- Benzylpenicillin
--- < 1 year: 300 mg?
--- 1-9 years: 600 mg?
--- Adult and child aged 10 or older: 1200 mg
- Cefotaxime (better)
--- < 12 years: 50 mg/kg?
--- ≥ 12 years/adults: 1g? Alternatively: ceftriaxone
Safety advice given in children with not clear diagnosis?
Link to PIL ‘Spotting sepsis in children’ from Sepsis Trust given?
Resource(s):
CKS: Meningitis - bacterial meningitis and meningococcal disease