Page 267 - ATP-P 11th Ed

MENINGITIS PROTOCOL

SPECIAL CONSIDERATIONS
1. May be bacterial, viral, or fungal. The bacterial type may cause death in hours,
even in previously healthy young adults, if not treated aggressively with appro-
priate antibiotics.
2. Consider malaria as a differential diagnosis. Treat for both if malaria cannot be
ruled out. SECTION 2

Signs and Symptoms
1. Classic features include:
a. Severe headache
b. High fever
c. Pain with any neck movement, particularly forward flexion
d. Altered mental status
2. May also include:
a. Photophobia
b. Nausea and vomiting
c. Malaise
d. Seizures
3. Positive Brudzinski’s (pain with head and neck flexion) and Kernig’s (neck pain with
hip flexion and knee extension) signs
Management
1. If meningitis is suspected, treatment should be initiated immediately.
2. IV access
3. Dexamethasone (Decadron ) 10mg IV/IM q6hr
®
4. Ceftriaxone (Rocephin ) 2g IV q12hr (IM route possible alternative but prefer IV
®
route)
5. Treat per Pain Management Protocol.
6. Treat per Nausea and Vomiting Protocol.
7. If seizures occur, treat per Seizure Protocol.
8. Moxifloxacin (Avelox ) 400mg PO once OR ceftriaxone (Rocephin ) 250mg IM
®
®
for prophylaxis of close contacts
Disposition
Urgent evacuation

256 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 257