Page 141 - 2022 Ranger Medic Handbook

Meningitis
DEFINITION: Inflammation of the meninges and spinal cord by bacterial, viral, or fungal agents.
S/Sx: Classic features include: severe headache, high fever, pain with any neck movement (particularly forward flexion),
altered mental status; may also include: photophobia, nausea and vomiting, malaise, seizures; positive Brudzinski (pain
on head and neck flexion, causing hips/knees to flex) and Kernig’s (neck pain with hip flexion and knee extension) signs.
May have petechiae in meningococcemia (mask and gown PPE if suspected)
MANAGEMENT:
1. If meningitis is suspected, treatment should be initiated immediately.
2. Gain IV access.
3. Dexamethasone 10mg IV/IM q6hr.
4. Ceftriaxone 2g IV q12hr (IM route possible alternative but prefer IV route).
5. Treat per Pain Management Protocol.
6. Treat per Nausea and Vomiting Protocol. SECTION 3
7. If seizures occur, treat per Seizure Protocol.
8. For prophylaxis of close contacts: Rifampin 600mg PO bid for 2 days OR ceftriaxone 250mg IM once.
DISPOSITION: Urgent evacuation.
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.

Motion Sickness & Prevention
DEFINITION: Not a true sickness, but a normal response to a situation in which sensory conflict about body motion
exists among visual receptors, vestibular receptors, and body proprioceptors. Referred to as air sickness, car sickness,
sea sickness, and physiologic vertigo.
S/Sx: Nausea; vomiting; diaphoresis; pallor; hypersalivation; yawning; hyperventilation; anxiety; panic; malaise; fatigue;
weakness; confusion; dizziness.
PREVENTION:
1. Meclizine 25mg PO taken 30–60 minutes before travel and bid OR 1× scopolamine transdermal patch 1.5mg behind
ear up to 4 hours prior to travel.
2. If possible, sit in middle of plane/boat or fix vision on horizon while avoiding fixation on moving objects.
3. Minimize food intake before travel and increase airflow around face.
MANAGEMENT:
1. Manage as per Nausea and Vomiting Protocol.
2. For severe responses or vertigo, consider Midazolam 1–2mg IV q6–12hr.
DISPOSITION: Evacuation not required unless individual’s performance becomes a risk to mission, self, or others. Con-
sider routine evacuation or complete reevaluation if S/Sx do not alleviate < 24 hours after last motion travel.
SPECIAL CONSIDERATIONS:
1. Ensure differential diagnosis from altitude illness, gastroenteritis, central neurologic cause or stroke (evaluate and
treat per ACLS guidelines), and toxin exposure.
2. All above medications may cause drowsiness and should be considered for mission impacts.

2022 RANGER MEDIC HANDBOOK 127