khorshid
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A3 year-old girl presents with lethargy, fever, severe headache and a stiff neck. On examination, a unilateral fixed, dilated pupil and papilledema are noted. Which of the following is the most appropriate initial step in managing this patient?
A)administration of IV cefotaxime
B) administration of IV mannitol
C) CT of head
D) intubation and hyperventilation
E) LP
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| elitoki
Forum Guru
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C , meningitis ?
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| usmlestud
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bb
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| fudoc_20
Forum Newbie
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yeah B .there are clear signs of increased intracranail tension ! and there is apapilledema so we have to give mannitol to decrease it by osmotic diuresis
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| archanavt
Forum Newbie
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there is unilat fixed dialated pupil---------rule out SOL first. i'll go for CT 1st.
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| virgola82
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I think she should undergo CT for sure (->lethargy and papilledema) but what about giving antibiotics first? When should they be given? I think I would pick A
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| khorshid
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Well first of all I am sorry guys, this was a "13" yo girl, I misstyped it. And the correct answer is D.Because hyperventilation is the most appropriate immediate nonsurgical treatment of intracranial HTN. Then cultures, then antibiotics and then CT. It says IV mannitol to be bery effective too, but it doesn't say in which exact order does it come.
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| sandra
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its d coz its the quickest way to lower ICP..mannitol would take longer to act
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| young_doc
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But why would we need to intubate her? I don't think the answer should be D. There are no signs of respiratory distress in the question. We don't intubate everyone who comes in with suspected meningitis in order to induce hyperventilation!
Mannitol is not commonly used in Meningitis.. Steroids are preferred to reduce cerebral edema.
Empiric antibiotics should be given first, followed by a CT, then LP.
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| sandra
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@khorshid..whts the correct answer as per the source of q?
i think raised icp shud be corrected even b4 starting antibiotics coz its more urgent n the quickest way to do that is to induce hyperventilation by intubation. intubation is done to create hyperventilation.
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| khorshid
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Per source of q which gives ref to McMillan et al, the correct ans is intubation and hyperventilation(most appropriate nonsurgical tx of icp) Then blood cultures ,thenIV Ab, then CT, (LP next if necessary), and if in midst of all these procedures you still needed an extra effort to lower icp, you can use IV mannitol.
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