Wednesday, January 2, 2008

Vol 2:1 Question






You think your headache is bad...Give this week's quizzER a try!

Headache
A 21-year-old college student is brought by her roommate to the ED. The roommate states that earlier in the day the patient complained of a severe headache, stiff neck and photophobia. On their way to the ED, the roommate states that the patient was confused. Her vital signs are BP 110/80 mm Hg, HR 110 beats per minutes, RR 16 breaths per minute, and temperature 102°F. What is the next step in the management of this patient?
a. Start empiric antibiotics, non-contrast head CT prior to performing lumbar puncture
b. Order a non-contrast head CT and start antibiotics once the results are back
c. Give 1 gram of acetaminophen, start fluid hydration and perform a lumbar puncture
d. Perform a lumbar puncture and start antibiotics once the results are back
e. Order a non-contrast head CT, perform LP, then start antibiotics

Please submit your answer in the "comment" section. The person with the most correct entries at the end of the month will receive a copy of the book PreTest Emergency Medicine.

For more information about the contest, please click here.

quizzER is a weekly contest consisting of a question selected from various areas of emergency medicine that are central to the education of medical students and residents in training. For more information please refer to the following link.

12 comments:

AMiB said...

e. wait till after the lp to give abx, in order to not contaminate the sample

WongML said...

a. Start empiric antibiotics, non-contrast head CT prior to performing lumbar puncture.

The EMRA Top Clinical Problem's booklet says that in cases of suspected meningitis antibiotics should be started right away, without waiting for a LP. "A" is on the only answer that is consistent with that recommendation.

HicksterAZ said...

e. CT (get results), LP, then abx

ptk said...

Answer: A

prnpenguin said...

A). Start empiric antibiotics, non-contrast head CT prior to performing lumbar puncture.

Possible meningitis or low grade SAH?

NPG said...

A. Start empiric antibiotics, non-contrast head CT prior to performing lumbar puncture

doctor j said...

E.

rune said...

e. non contrast CT (if stat) - lp - empiric antibiotics

The T-Dude said...

I would have to go with answer A.

In my mind, we are looking at two primary possibilities: aneurysm or meningitis, with the fever leaning me toward meningitis. Therefore I would start antibotics, get a CT and then go for the lumbar puncture.

Kim said...

I'm going to say "c", as that is what would happen on presentation to my ER - the nurses would give Tylenol, start the IV and with those sx, a lumbar puncture is in the plan, although a CT might be done eventually.

marcfeld said...

I would say E. I'm thinking meningitis as the diagnosis - college student, headache, etc.
CT to r/o bleed or changes, ABT, and LP.

Fat Lazy Male Nurse said...

a