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Bacterial meningitis — RCPSC EM MCQ

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HardNeurological emergenciesBacterial meningitisRCPSC EM

A 52-year-old has fever, confusion, neck stiffness and petechiae. CT is not immediately available; BP is 104/62 mmHg, GCS 12 and there is no focal neurologic deficit. What is the next step?

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Correct answer: D — Give ceftriaxone, vancomycin and dexamethasone now

The best answer is “Give ceftriaxone, vancomycin and dexamethasone now”. Suspected bacterial meningitis with possible meningococcal disease needs immediate empiric antibiotics and dexamethasone. Blood cultures and lumbar puncture are obtained when they do not delay treatment; CT is not a reason to postpone antimicrobials in a deteriorating or high-risk presentation. Isolation and public-health steps follow according to local protocol.

Reference: Emergency Care BC: Meningitis—Management: https://emergencycarebc.ca/clinical_resource/clinical-summary/meningitis-management/