The Internet Book of Critical Care Podcast IBCC Episode 13 Meningitis
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Nov 28, 2018 This podcast explores the identification and treatment of central nervous system infections like meningitis and encephalitis. Topics covered include management of stuporous or comatose patients, interpretation of CSF tests, use of MRI and CSF drainage, patterns of inflammation in meningitis, and key pearls for managing meningitis and encephalitis.
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Suspecting CNS Infection
- CNS infection suspicion requires infection signs plus neurological issues without other explanation.
- Classic signs like nuchal rigidity are not fully reliable, so maintain a broad, cautious view.
Immediate Management Steps
- Initiate droplet precautions and empiric treatment (dexamethasone, ceftriaxone, acyclovir) when meningitis is suspected.
- Don't delay antibiotics and steroids for lumbar puncture if index of suspicion is medium or high.
Airway Management in CNS Infection
- Intubate stuporous or comatose patients to secure airway before imaging and LP.
- Prevent ICP compromise by avoiding hypotension and hypercapnia during intubation, using rapid sequence technique.