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  #1  
Old 07-22-2013
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Default Meningitis best initial step

I always get this wrong!

Is this correct?

- adults suspected with meningitis: antibiotics first, then LP (when there are no signs of increased ICP) or CT (when there are signs of increased ICP).

- children suspected with meningitis: LP first, then antibiotics (no matter what the status of ICP is)
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  #2  
Old 07-22-2013
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Quote:
Originally Posted by Renaissance View Post
I always get this wrong!

Is this correct?

- adults suspected with meningitis: antibiotics first, then LP (when there are no signs of increased ICP) or CT (when there are signs of increased ICP).

- children suspected with meningitis: LP first, then antibiotics (no matter what the status of ICP is)
always atb first
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  #3  
Old 07-22-2013
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That's what I answered just now on UW!

Question ID 3633, UW:

The answer is LP then antibiotics despite the clear presentation of meningitis in an 8-month old boy.

The explanation says: infants should always get an LP followed by antibiotics
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Old 07-22-2013
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i think confusion + signs of meningitis should guide to rx not the sge, if confusion positive then antibiotic first if no confusion n no signs of icp or focal neurological deficit then lp first
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Old 07-22-2013
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ok i revised this portion - here it goes

if pts needs CT - 1.you do take blood samples for Cx 2. Abx. 3.Ct 4.LP
If no CT needed - 1.Culture2.LP.3ATB
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Old 07-22-2013
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If patient has focal neurological deficits or Altered Mental Status that would otherwise make examination for focal neurological deficits useless. You do antibiotics first

If there are no signs of deficits, then do LP and then give antibiotics
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i think the logic here is - you need a sample to culture first (unaffected by antibiotics)
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Old 07-23-2013
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Thanks guys
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Old 07-24-2013
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Extra tip if anyone's interested.

Infants (less than 1 year) rarely develop herniation due to open fontannelles. So an LP can be done in the presence of signs of increased ICP.
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Old 07-30-2013
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my understanding has been this:

kids: LP then antibiotics

adults: LP then antibiotics, UNLESS you're doing a CT instead of LP, in which case you do antibiotics then CT.

is this correct?

(and blood cultures come before all)
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Quote:
Originally Posted by Dr.NickRiviera View Post
my understanding has been this:

kids: LP then antibiotics

adults: LP then antibiotics, UNLESS you're doing a CT instead of LP, in which case you do antibiotics then CT.

is this correct?

(and blood cultures come before all)
- No increased ICP: LP then empiric antibiotics

- Increased ICP: empiric antibiotics then CT --> LP
In cases of increased ICP, a CT is done before LP to rule out any space occupying lesions.

- Infants (whether increased ICP or not): LP then empiric antibiotics
Infants less than a year have low risk of herniation due to open fontanelle. So an LP is done inspite of signs of increased ICP and with no CT needed.

The rule of thumb is that you do a quick LP before giving antibiotics. However, anything that delays this means that you give antibiotics right away.

This is my understanding and how I wrote it down in my head.
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Quote:
Originally Posted by Renaissance View Post
- Increased ICP: empiric antibiotics then CT --> LP
In cases of increased ICP, a CT is done before LP to rule out any space occupying lesions.
I do not think thats right - no point in taking LP after you messed up the juice with abx...
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Quote:
Originally Posted by DocSikorski View Post
I do not think thats right - no point in taking LP after you messed up the juice with abx...
Better to treat and decrease the accuracy of a test than to risk permanent brain damage...right?

Plus, there's always bacterial antigen detection (latex agglutination test) that is usually used in cases where antibiotics were given prior to LP
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Quote:
Originally Posted by Renaissance View Post
Better to treat and decrease the accuracy of a test than to risk permanent brain damage...right?

Plus, there's always bacterial antigen detection (latex agglutination test) that is usually used in cases where antibiotics were given prior to LP
hmmmmmmmmmmmmmm
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Quote:
Originally Posted by Renaissance View Post
- No increased ICP: LP then empiric antibiotics

- Increased ICP: empiric antibiotics then CT --> LP
In cases of increased ICP, a CT is done before LP to rule out any space occupying lesions.

- Infants (whether increased ICP or not): LP then empiric antibiotics
Infants less than a year have low risk of herniation due to open fontanelle. So an LP is done inspite of signs of increased ICP and with no CT needed.

The rule of thumb is that you do a quick LP before giving antibiotics. However, anything that delays this means that you give antibiotics right away.

This is my understanding and how I wrote it down in my head.
that's what i just said, right?
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Quote:
Originally Posted by DocSikorski View Post
I do not think thats right - no point in taking LP after you messed up the juice with abx...
antibiotics dont affect CSF, only blood cultures.
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Quote:
Originally Posted by Dr.NickRiviera View Post
antibiotics dont affect CSF, only blood cultures.
??
Than why do we give them to pts with meningitis?
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Quote:
Originally Posted by DocSikorski View Post
??
Than why do we give them to pts with meningitis?
to kill the bugs
what im saying (or heard, from a doc in rotations and also in kaplan i think) is that giving antibiotics doesn't cause a dramatic, if any, change in CSF leukocyte counts, so it wont affect your lumbar puncture... but it will affect your blood drawings.

it might be one of those, doesnt cross the blood brain barrier, thingies, but im not sure. all i know is thats what i was taught and thatll get you the right answers.
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