Meningitis - drnish00

[ArchivalUser]

Hey Guys,

For meningitis do we do the orders in the following steps.

1. Focused PE
2.Oxy, CBC, BMP, CXR, U/A, Blood Cultures, Urine output, iva, nss,

Than after blood cultures start empiric antibiotics with Vancomycin and Ceftriaxone but dexamethason before the antibiotics.

3. Head CT, phenergan, acetaminphine,
4. Once CT is normal. Lumbar puncture with CSF analysis.

Do we go to order sheet first or do Focused PE first? Archer says go to order sheet UW says Focused PE?

Thanks Guys

[ArchivalUser]

i guess u cud do either way...
if u do exam just do a 2 min exam first, shud not make difference as long as pt is not "unstable"

i wud do the blood culture.... advance clock 1 minute so system knows u did blood culture then give empiric abx...

[ArchivalUser]

@resi

Thanks buddy. ALso archer says that if the patient is in severe pain go straight to order sheet and give morphine. My question is aren't we not suppose to give Morphine in abdominal pain without finding out cause first?

Thanks
Nish

[ArchivalUser]

for any severe pain... u shud get rid of the pain first, but it all depends on case...

by doing a 2 min focused exam eg abd, cvs, lungs... u can rule out a lot of diagnosis... like guarding, rigidigy.... so thats why sometimes its better do to a P/E first....

[ArchivalUser]

also i wud just give phenargen in the beginning.... nothign wrong with that.

[ArchivalUser]

Archer says to always give morphine even if its an abdominal case and don't worry about masking the signs for any abdominal condition.

Also for meningits, make sure you order 'respiratory isolation' of the pt . You can cancel this later when you do LP culture and find that its not Neisseria meningitidis.

[ArchivalUser]

thanks buddy