You are working as a double crewed ECA Ambulance and are called to an 18-year-old female with a complaint of severe headache and vomiting. She has not long started her university course and a lot of her friends have been getting unwell with what people have been saying is ‘freshers flu’. Her symptoms seem to have got worse when her friends are recovering, and she grew concerned and called 999.
On arrival, the patient is in a dark room on her bed. She is alert but seems very drowsy. She states she started having flu-like symptoms with fever, joint pain and lethargy, but then she developed a headache and vomiting. The headache is worse with the lights on.
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What medical term refers to a hypersensitivity to light?
You obtain your basic observations. They are: 130 HR, 24 RR, 95/68 BP, 94% Sp02, Temp 38.2, BM 4.9.
What is this patients NEWS score?
The patient describes the headache as progressive, persistent, generalised and severe. It is also associated with pain at the back of her neck. This presentation is typical of a thunderclap headache?
You conduct further questioning with the patient. She has no past medical history including no migraines, and no allergies. She has been unable to eat or drink much over the last 24h and feels she has been unable to get out of bed. Her headache has developed into severe pain over last 48 hours starting with her flu-like symptoms. No trauma has been involved. She hasn’t vomited for last 12 hours but is still feels nauseous.
What other assessments would you deem important to complete in this case? TICK ALL THAT APPLY
You find the patient to have no other neurological symptoms however is positive for Kernig’s sign. Pupils are equal and reactive. She is Fast negative. Her skin looks mottled especially on her peripheries, but you don’t see any rashes.
What significant differentials would you currently suspect?
What kind of rash would you typically see with meningitis?
Approximately what population of patients with confirmed meningitis will report the typical meningitis rash as a sign on presentation to healthcare?
If a rash is found but is non-blanching, this will exclude the possibility of the rash being associated with meningitis?
You are concerned about the patient and ask for paramedic backup, control tell you they are 50 minutes away. You think you can get the patient to hospital in 10 minutes including a safe extrication to your vehicle. What would you plan for your treatment and management plan? TICK ALL THAT APPLY.
What medication is paramount to give as soon as possible in meningitis cases?
If a patient with meningitis is known to have a mild reaction to penicillin with a mild rash, can benzylpenicillin still be given?
A headache caused by suspected meningitis is referred to as a primary headache?
Meningitis is the inflammation in the meninges. What are the meninges?
How can meningitis be transmitted from person to person?
Is meningitis a notifiable disease to Public Health England/Wales?