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State of Queensland (Queensland Health) 2012
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Initials Signature Print Name Role Initials Signature Print Name Role
SW285%
Brisbane North 3624 1111 Darling Downs 4631 9888 Moreton Bay (Redcliffe) 3142 1800 Townsville 4753 9000
Brisbane South 3000 9148 Gold Coast 5668 3700 Mt Isa & Gulf 4744 9100 West Moreton (Ipswich) 3413 1200
Cairns 4226 5555 Logan 3412 2989 Rockhampton 4920 6989 Wide Bay (Hervey Bay) 4184 1800
Central Queensland 4920 6989 Longreach 4652 6000 South West 4856 8100 Wide Bay (Bundaberg) 4150 2780
(Rockhampton) Mackay 4911 0400 Sunshine Coast 5409 6600
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Emergency Management of Children with Meningitis
Child presents to emergency service with clinical features suggesting Consider differential diagnoses:
meningitis viral encephalitis
intra-cranial collections
eosinophilic meningitis
Assessment
acute disseminated
Assess Severity
encephalomyelitis (ADEM)
Consider pre-hospital management given
"mimics" of meningitis, e.g. other
infectious diseases.
Stable Unstable
*Contraindications for LP: altered level of consciousness or
child unstable
obtundation
altered LOC or obtundation
signs of shock
Is an LP seizures
coagulopathy
contraindicated?* Y suspicion of space occupying
refactory seizures
lesion or ICP
localised infection in the lumbar
N region Emergency Management
coagulopathy (Resuscitate using ABCD)
Call emergency &/or paediatric
Can LP be performed consultant
N
within 30 mins?
A Provide high-flow oxygen
B Support ventilation (BVM)
Y B Consider ETT intubation if not
responding
Perform LP Delay LP C Obtain IV or IO access
Investigation and treatment
Add viral studies depending Within 30 mins of C Give IV fluid boluses 20mL/kg
on clinical suspicion assessment: 0.9% NaCl as required
Blood cultures Call emergency &/or D Check BSL and give IV 10%
Meningococcal PCR (CSF paediatric senior doctor Dextrose (2mL/kg) as required
+ blood) if meningococcal Blood cultures and if Other treatment:
disease suspected) meningococcal disease Blood cultures
suspected perform Meningococcal PCR (blood) if
Administer Dexamethasone meningococcal PCR meningococcal disease suspected
plus empirical IV antibiotics Administer Dexamethasone Administer Dexamethasone plus
Add IV Acyclovir if plus empirical IV antibiotics empirical IV antibiotics
N Add IV Acyclovir if Add IV Acyclovir if
clinical suspicion of HSV
meningoencephalitis# clinical suspicion of HSV clinical suspicion of HSV
meningoencephalitis# meningoencephalitis#
Is an LP
contraindicated?* Y Improvement?
Negative Positive
*Contraindications for LP:
Continue observation in child unstable
ED or SSU altered LOC or obtundation
Y seizures N
suspicion of space occupying
Meets discharge lesion or ICP
N
Disposition
Clinical features of meningitis (at any age) Additional clinical features of meningitis
Fever Nuchal rigidity Altered mental status in infants less than 3months
Vomiting and/or nausea (often not present, Shock Bulging fontanelle High pitched cry
Lethargy or irritability especially in young Seizures Poor feeding Apnoea Seizures
Photophobia and/or children and infants Meningeal signs # Consider HSV meningoencephalitis if a history
headaches Positive Kernig's or Focal neurological deficit of maternal HSV infection and predominance of
Anorexia Brudzinski's sign Petechial rash lymphocytes in the CSF
Reference: Children's Health Services Meningitis
Page 2 of 2 Clinical Procedure Working Group 2011