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
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12 comments:
e. wait till after the lp to give abx, in order to not contaminate the sample
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.
e. CT (get results), LP, then abx
Answer: A
A). Start empiric antibiotics, non-contrast head CT prior to performing lumbar puncture.
Possible meningitis or low grade SAH?
A. Start empiric antibiotics, non-contrast head CT prior to performing lumbar puncture
E.
e. non contrast CT (if stat) - lp - empiric antibiotics
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.
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.
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.
a
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