EMCrit Podcast EMCrit Podcast 28 – Severe CNS Infections
Aug 26, 2010
How to recognize meningitis quickly using key red flags like headache, fever, neck stiffness, and AMS. Practical strategies for immediate isolation and when to give empiric antibiotics. Clear rules for when to get CT or perform lumbar puncture and tips for safe airway control and neuroprotective intubation. Practical guidance on CSF testing, steroid timing, and emerging rapid diagnostics.
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When It Is Safe To LP Without A Head CT
- You may perform LP without CT only in meticulously selected patients: perfect mental status, no focal deficits, not immunocompromised, and no raised ICP.
- Weingart prefers ocular ultrasound of optic nerve sheath over fundoscopic papilledema exam.
Intubate And Neuroprotect Before CT In Uncooperative Patients
- If an obtunded suspected meningitis patient needs CT, secure the airway with a neuroprotective intubation before transport.
- Maintain oxygenation and blood pressure; avoid leaving a hostile patient unanesthetized for CT.
Always Do LP In Lateral Recumbent To Measure Opening Pressure
- Perform lumbar puncture in lateral recumbent position to obtain opening pressure; avoid seated LPs because they don't give opening pressure.
- Opening pressure is crucial to detect raised ICP, cryptococcus, and idiopathic intracranial hypertension.