Adult Medical Emergency Handbook - Scottish Intensive Care Society

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• EDTA blood sample for PCR (pink tube, as FBC).
• Coagulation screen.
• Throat swab in viral transport medium and stool for viral culture.
State clearly on request form “meningitis”.
• If clinical features suggest recent mumps, parotid duct swab in
viral transport medium.
• Lumbar puncture: see below re CT scanning. A CT scan may
be required first if a mass lesion, or abscess is suspected, i.e.
focal neurological signs, papilloedema, middle ear pathology,
or a history suggestive of a neoplasm or if profoundly
immunosuppressed eg HIV positive. Check opening pressure, if
>35 cmH 2 O, remove only the fluid in the manometer and refer to
ICU urgently (see next page). Otherwise try and send at least 5ml
to Microbiology (greatly increases diagnostic yield). One sample to
microbiology for MC&S, one to biochemistry for glucose, protein,
and xanthochromia if subarachnoid haemorrhage is a possibility,
and one to Virology.
• Contemporaneous blood glucose.
• Contraindications to lumbar puncture include signs of raised
intracranial pressure, (including reduction in conscious level,
focal neurological signs) or major coagulopathy.
• CXR
Normal CSF is gin-clear. Any haze/turbidity is an indication for
immediate antibiotic if not already given.
Cell count
Cell type
(normal up to 5
lymphocytes)
Protein
(normal