Page 136 - PJ MED OPS Handbook 8th Ed

Meningitis

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 appropriate antibiotics.
2. Consider malaria as a differential diagnosis. Treat for both if malaria cannot be ruled out.

Signs and Symptoms:
1. Classic features include:
a. Severe headache
b. High fever
c. Pain with any neck movement, particularly forward flexion (ask patient to touch his chest
with his chin)
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. Establish IV access.
3. Dexamethasone (Decadron) 10mg IV/IM q6hr; first dose with or prior to antibiotic
administration.
4. Antibiotic coverage:
a. Ceftriaxone (Rocephin): 2g IV q12hr (IV preferred/IM if required OR
b. Ertapenem: 1g IV q24hr(IV preferred/IM if required)
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.
DISPOSITION:
1. Urgent evacuation.

134 n Pararescue Medical Operations Handbook / 8th Edition