Meningitis Scenario (ECA)

What assessment tool can you use alongside the start of your DR ABCs that can help you gain a quick first impression of the condition of your paediatric patient?

After using your paediatric assessment tool and DR ABCs, you are increasingly concerned. You observe increased work of breathing at a higher rate, a red prickly rash on the inside of the elbows, and the patient does not appear to be responding as you would expect; they seem exhausted. Your Paramedic colleague asks if you could complete the first set of observations while they obtain a more detailed history from the parents.

You collect the following observations: RR 38, SpO₂ 95%, HR 155, Temp 38.1, BM 4.3. They have no past medical history, and you find moderate recession.

What is this patient’s POPS score? 

As your concern grows and the patient appears quite pale, you also record a blood pressure reading of 85/56. Would this reading be normal for a patient of this age?

You overhear that the patient has no allergies, has been fighting a viral infection for 2 weeks, seemed to improve after seeing a GP last week, but has deteriorated again. Today they have been very irritable and inconsolable, and over the last hour have appeared listless. You begin to complete some neurological assessments. 

They open their eyes to speech, respond in a confused manner, intermittently cry irritably, and localise to pain. What is the patient’s GCS?

You also shine your pen torch into the patient’s eyes to assess their pupils. In doing so, you appear to cause discomfort and the patient begins to cry again. You manage to get a sufficient look to note that the pupils are reacting, but you are not fully confident. What is this sign known as?

You inform your colleague of your findings, and your shared concern increases in urgency. They ask the parents to prepare to leave while you assist in getting the patient ready for transport. Before leaving, your colleague lays the patient flat on their back, lifts one knee so it is flexed at 90 degrees at the hip, then extends the leg to straighten it while observing for a reaction. The patient groans during this manoeuvre. 

What is this test called? 

If the patient is positive for Kernig’s sign, what does this indicate?

The patient is displaying multiple red flag signs for meningitis. Your colleague asks you to help prepare the patient for transport while they obtain medications. While doing so, you reassess the patient’s rash that was reported initially. They have a red, prickly rash on the inside of the elbows, which blanches when pressed. This description matches what is expected of a purpuric rash associated with meningococcal septicaemia.

Your colleague returns with medication prepared. What medication have they most likely drawn up?

Your colleague returns with Benzylpenicillin. According to JRCALC, are they able to administer it to a suspected meningitis patient if they do not have a purpuric rash?

As you rapidly prepare the patient for ambulance transport, you consider whether managing meningitis cases requires additional PPE. How is meningitis transmitted from patient to patient?

You are less concerned about PPE requirements as the patient has not been coughing or sneezing, and you have maintained distance where possible. You secure the patient onto the ambulance stretcher. Where does this patient require transport to?

Is it only children who can contract meningitis?

Why may a patient with meningitis complain of photophobia?

Which layer is not part of the meninges?