Background
History
- Headache/Photophobia
- Neck & back stiffness
- Vomiting/off feeds
- Lethargy/altered conc
- Irritability (infant)
- Fever
- Rash (meningococcal)
Classic clinical features of meningococcal disease can appear relatively late in the illness, early clinical features include:
- Leg pains
- Cold hands & feet
- Abnormal skin colour 8
Examination
- Ensure Airway is clear
- Breathing pattern is ok
- Circulation pulse rate & vol, BP, capillary refill
- Pyrexia
- Skin Changes
- Rash (meningococcal)
- Meningism
- Bulging Fontanelle
- Decreased Level Conc
- Signs of raised ICP:
- Fluctuating conc
- Hi BP & relative bradycardia
- Pupils unequal
- Focal neurology
- Seizures
- Posturing
- Papilloedema (late)
Suspect Sepsis if
- Tachycardia
- Low volume pulse
- Capillary refill (>3 sec)
- Skin to core temp difference
- Evolving rash
- Oliguria (<1ml/kg/hr)
- Hypotension (late sign)
Suspect Cerebral Oedema
- Na <135mmol/L &
- Signs of raised ICP (see column to left)
or - Na<130mmol/l without clinical signs
Beware
Bad Prognostic Signs
- Differential skin/core temp > 3OC (children)
- SBP < 85 mm Hg (age > 4yrs)
- Systolic BP < 75 mm Hg (age < 4yrs)
- WCC <10.0 x109/L
- Metabolic acidosis
- BE > -5.0 mmol/l
or - Lactate > 5
or - Lactate rising
- Coagulopathy
- Rapidly evolving characteristic rash
- Glasgow meningococcal prognostic score (GMPS) > 8
- BE > -5.0 mmol/l
Algorithm
| Adults & children > 10 yrs | 1200 mgs |
| Children 1 - 9 yrs | 600 mgs |
| Children < 1 yr | 300 mgs |
Pre-hospital Antibiotics
The doses of benzylpenicillin (ideally IV but can give IM, although may not be as effective) for GP use in suspected meningococcal infection are:
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