ID seminar Severe sepsis and meningitis

Severe sepsis and meningitis

- worksheet
Learning Objectives
The use of basic observations tools for urgent management of severe infection. The
diagnosis: history, examination and investigations, of meningitis. The immediate initial
management of meningitis
For the discussion to be successful the student should read through the VLE
notes on this topic before the seminar
N.B. the order of the cases may vary
Case 1 - You are an FY1 in MAU
A 34 year old female is referred by her GP unwell and vomiting. Her son had
chickenpox 3 weeks ago and she developed a rash 7 days ago. She was prescribed
aciclovir and the rash has begun to crust
One of the lesions on her shoulder has become more painful and devoped progressive
surrounding erythema
You are asked to review the patient following her admission to the MAU
She is pyrexial at 38.5 C, pulse 120/min, BP 80/60, SaO2 92% (room air), respiratory
rate 26/min. GCS 15 but agitated, MEWS 10
Questions to be discussed in the seminar:
Who else should be involved in this patients care?

What is the most likely reason for her deterioration?

What immediate management would you start?

ID seminar Severe sepsis and meningitis

Case 2 - You are an FY1 in MAU

A 23 year old male student is admitted with a 24 hour history of worsening headache.
He has felt unwell, sweaty, cant stand bright light
He is alert and orientated but has photophobia and neck stiffness. Temp 38.5, pulse
100/min, BP 110/90, Resp 18, Neck stiffness present, Kernig's sign positive. No rash
(MEWS 3)
Questions to be discussed in the seminar:
What immediate management should be done?

CT brain before LP?

What is the most likely diagnosis

What further tests on the CSF should be requested?

What treatment is required

Case 3 You are an FY1 on MAU

A 47 year old woman shop assistant is admitted with a 3 day history of headache,
chills, and a cough
She had become increasingly confused and drowsy over the last 4 hours and had a
generalised convulsion in A&E
She is unwell, Temp 39, pulse 130/min, BP 70/50, Resp rate 28. GCS 11
Chest a few crackles at the left base, no focal neurology, neck stiff, no rash

Questions to be discussed in the seminar:

What is the likely diagnosis?

What is your immediate management?

CT brain before LP?