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Clinical Emergencies in GP

Clinical Emergencies in GP. Meningitis. What is it?. Inflammation of the pia and arachnoid membranes. Causitive organism can be viral, bacterial, fungal, others or traumatic. Meningitis represents a variety of illness with varying severity. 90% of cases occur in the first five years of life.

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Clinical Emergencies in GP

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  1. Clinical Emergencies in GP Meningitis

  2. What is it? • Inflammation of the pia and arachnoid membranes. • Causitive organism can be viral, bacterial, fungal, others or traumatic. • Meningitis represents a variety of illness with varying severity. • 90% of cases occur in the first five years of life.

  3. Bacterial Meningitis. • Mortality can be between 10-20% even in those who receive optimal treatment. • Swift action is needed. • Causative organism is thought to be age dependant. • Neonates- E-coli, gram –ve, group B strep and listeria • Children-haemophilis influenza (<5yrs numbers have fallen since Hib vaccination), neisseria meningitidis, TB, Streptococcus pneumoniae

  4. Bacterial Meningitis 2 • Young adults-Meningococcus (gram –ve, most common cause of pyrogenic meningitis), Leptospira ictohaemorrhagiae. • Older adults-Pneumococcus. • Elderly-Pneumococcus, Listeria and gram negatives.

  5. Epidemiology • In 1992 there were 1,138 cases mostly caused by strep viridans (epidemic capability-African meningitis belt.) • Back then only 30% of cases were given benzylpenicillin by their GP before admission.

  6. Meningism -headache -photophobia -stiff neck Kernig’s sign-with hips fully flexed, resists passive knee extension Raised ICP -Irritability -Drowsiness -fits -vomiting -decreased pulse rate -increased BP -bulging fontanelle -abnormal tone/posture Rapid onset of symptoms

  7. Rapid onset of symptoms • Septicaemia • -rash • -fever • -arthritis • -tachycardia • -peripheral shut down • -tachypnoea • Small children/immunocompromised/elderly pt’s may not present typically.

  8. Action • Call 999-get the patient to hospital as soon as possible. • Give IV/IM benzylpenicillin immediately while awaiting transport. • -Adult and child (>10yrs) 1.2g • -Child 1-9 yrs 600mg • -Infant <1yr 300mg • Cefotaxime for penicillin allergic patients • If possible IV access and blood cultures

  9. Secondary Care • If bacterial meningitis is suspected an LP must be performed (unless contraindicated). • Send CSF for gram satin, culture and sensitivity, cell count, glucose, protein and PCR. Take serum for comparison. • Do not delay treatment for LP. • CT scan if any doubt or raised ICP or focal signs • LP findings can point towards the cause e.g. Fungal infection high protein,

  10. Contact Tracing • Notifiable disease-contact tracing by local public health department. • For single cases only treatment for very close contacts. • Prophylaxis-rifampicin 600mg BD for 2 days or single dose of ciprofloxacin 500mg. • Childs dose of rifampicin-10mg/kg for 2 days <1yr 5mg/kg for 2 days.

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