Guidelines for the Early Clinical and Public Health Management of ...

More documents

Recommendations

Info

Guidelines for the Early Clinical and Public Health Management of Bacterial Meningitis (including Meningococcal Disease) 9. IF CEREBRAL OEDEMA/RAISED ICP, PATIENT REQUIRES INTENSIVE CARE with GUIDED NEUROLOGICAL CARE 30-degree - head-of-bed elevation, midline position Avoid internal jugular vascular access Repeat mannitol and furosemide if indicated Sedate Cautious fluid resuscitation but shock must be corrected Minimal handling, monitor pupillary size and reaction Cooling -The role of cooling in adults is very uncertain- it reduces ICP but no clear evidence of benefit on outcome 10. CONSIDER INTUBATION Intubation may be required if there is: • an altered level of consciousness • ↑ ICP • if pulmonary oedema is anticipated -if >40-60 mls/kg of resuscitation fluid Early intubation can be advantageous in children. In the unstable child, intubation is a prerequisite for inter-hospital transfer. If considering insertion of a central line, intubate first (regardless of level of consciousness). Secure airway Ventilate to control PaCO 2 (4 – 4.5 kPa)- normocapnoea Lessen hypoxaemia Reduce oxygen consumption Maintain inspiratory plateau
Guidelines for the Early Clinical and Public Health Management of Bacterial Meningitis (including Meningococcal Disease) 12. REASSESS CLINICALLY Monitor blood glucose and assess need for dextrose Hypoglycaemia should be treated with 5ml/ kg of 10% dextrose solution and subsequent inclusion of dextrose in maintenance fluids Assess K+ needs as soon as U&E results available Maintain glucose ≥ lower limit of normal, but < 10 mmol/L. Maintain K+ within normal range 13. IF MENINGOCOCCAL INFECTION SUSPECTED OBTAIN THROAT SWAB and/or PERNASAL SWAB 14. CONSIDER FURTHER CONSULTATION For epidemiological purposes Important as may be only site to yield isolate, especially, if antibiotics have been given. Throat swab - a full sweep of the pharyngeal wall and tonsils, from all patients. If not possible, obtain a pernasal swab rotated on the posterior pharyngeal wall Microbiology, neurology, nephrology, infectious diseases input may be helpful. Early orthopaedic input if required (for fasciotomy), plastic surgery if required Monitor epidemiology of bacterial sepsis and meningitis. Of critical importance in era of introduction of ‘meningitis vaccines’ 15. NOTIFY PUBLIC HEALTH AND INFECTION CONTROL as soon as possible Ensure Contact Chemoprophylaxis if necessary (See Chapter 7, 8, 9, Appendix 4) and information as per agreed protocol. Under the statutory Infectious Diseases Regulations 1981, amended 2003, cases or suspect cases of bacterial meningitis or meningococcal septicaemia must be notified immediately to the Department of Public Health (Medical Officer of Health). Telephone notification should be used initially, as a matter of urgency. This is the responsibility of the admitting team. All telephone notifications must be followed by written notification. -27-
Page 1 and 2: Guidelines for the Early Clinical a
Page 25: Guidelines for the Early Clinical a
Page 77 and 78:
Guidelines for the Early Clinical a
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
show all

Guidelines for the Early Clinical and Public Health Management of ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?