Summary
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Describe the epidemiology of meningitis
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1.2 million cases worldwide per annum
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Severe morbidity (disability) and mortality rate of over 20%
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Approximately 135,000 fatalities per annum
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Common in the "Meningitis Belt" in Africa from Senegal to Ethiopia.
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UK and Ireland have the highest incidence in Europe
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Describe the pathophysiology of meningitis
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Infection of the meninges, mainly the pia and arachnoid mater.
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Streptococcus pneumoniae and Neisseria meningitidis are the most common and most aggressive pathogens of meningitis.
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Inflammation also affects brain parenchyma, resulting in cerbral oedema and raised intracranial pressure
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Damage to brain structures can occur, and if untreated or treated late, cellular destruction will take place resulting in brain damage, and damage to cranial nerves.
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Describe the assessment process for a patient with meningitis
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Obtain an accurate history from the caregiver or parent.
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Assess for any life-threatening conditions in primary survey.
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Perform a detailed physical exam looking for signs of rash or meningeal irritation. Remember however that these may not be present in all patients.
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Check temperature, many patients with bacterial meningitis will be pyrexial. Children with septicaemia often have rigors.
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Perform point of care lactate, VBG and electrolyte testing if available to help guide fluid and shock therapy.
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Outline the signs and symptoms of meningitis
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Symptoms and signs may vary from patient to patient
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Only half of patients will develop the classic signs of bacterial meningitis - headache, fever, neck stiffness and altered mental status
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Signs and symptoms in infants and younger children can be subtle, and can range from irritability, drowsiness, vomiting and diarrhoea to seizures, headache, difficulty breathing and unconsciousness.
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Signs of septicaemia can occur independently of meningitis.
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Signs of meningeal irritation are not always present.
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Describe the management of a patient with meningitis
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Ensure appropriate infection control measures are taken
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Manage any identified life threatening conditions
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Provide supportive therapy as required, including fluid resuscitation
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Administer antibiotic therapy
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Consider administration of corticosteroids in conjunction with antibiotic therapy
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Pre-alert ED and activate care pathway if available
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List the infection control precautions required when dealing with a patient with suspected meningitis
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Perform adequate handwashing prior to, during and after patient contact
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Wear gloves and standard precautions throughout the assessment and management of the patient
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Wear faceshield and mask if performing invasive airway manouevres
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If exposure to droplets occurs, seek occupational health advice or follow local exposure protocols
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Ensure your vaccination status is current
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Remember, many patients with meningitis will not present with classic signs and symptoms, and physical examination alone has been shown to be insufficient to diagnose meningitis. Paramedics should always maintain a high index of suspicion for meningitis in the unwell child.