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Meningitis

  • Admission orders

    • Admit: ICU, Droplet Precautions
    • Diagnosis: Meningitis
    • Condition: Guarded
    • Vital Signs: q 4, neuro checks q 2 x 24 hours
    • Allergies:
    • Nursing: Fall precautions
    • Diet:
      • if AMS, NPO now, swallow assessment in AM
      • regular if no AMS
    • Activity:
    • Labs:
      • CBC with platelets, Chem, LFTs
      • Coags: PT, PTT
      • Blood cultures x 2 immediately, prior to antibiotics
      • head CT (do before LP if suspect ICP or hernia risk)
      • LP: cell count, diff, gram stain, culture, protein, glc, PCR for enteroviruses
    • IV: D5 1/2 Normal Saline (NS) at 100 mL/h. Heplock if PO Intake Adequate
    • Special: ID consult if recent neurosurgery, head trauma, shunts, immunosuppression
    • Medications:
      • LP, blood cx before giving antibiotics
      • Dexamethasone 0.15 mg/kg IV now, then q 6 hours. First dose must be given along with antibiotics
      • Ceftriaxone 2 g IV q 12 hours, first dose now
      • Vancomycin 1 g IV q 12 hours, first dose now
      • Ampicillin 2 g IV q 6 hours, first dose now
    • Call HO: temp > 38.5 C, HR > 110, SBP < 100, changing neurologic status
  • Discharge

    • criteria: afebrile, stable, no neuro abnormalities, supportive home environment, clear plan for f/u
    • meds: PICC line for completion of outpt IV antibiotics
    • f/u with ID or neuro in 1 week

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