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Major incident declaration — DIPIMC MCQ

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A university student has fever, confusion, purpura, limb pain and shock. Strongly suspected meningococcal disease is pre-alerted, IV access is present and giving an antimicrobial will not delay transfer. What should be done?

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Correct answer: B — Give IV or IM ceftriaxone or benzylpenicillin during emergency transfer

The best answer is “Give IV or IM ceftriaxone or benzylpenicillin during emergency transfer”. NICE recommends IV or IM ceftriaxone or benzylpenicillin as soon as possible outside hospital for strongly suspected meningococcal disease unless administration would delay transfer. ABC resuscitation, shock treatment and emergency pre-alert continue in parallel. Cultures and lumbar puncture are hospital investigations and must not postpone time-critical transfer, while oral treatment is inappropriate in a shocked patient.

Reference: NICE NG240, Meningitis and meningococcal disease: https://www.nice.org.uk/guidance/ng240/chapter/recommendations