emDOCs / EM@3AM - January 28, 2023 - By Mounir Contreras Cejin; Zachary Aust
Reviewed by Sophia Görgens; Cassandra Mackey; Alex Koyfman; Brit Long
Pearls and Pitfalls
- The classic triad of fever, nuchal rigidity and altered mental status is seen in less than 50% of adult cases of bacterial meningitis.
- Do not rely on Kernig or Brudzinski signs, as these have poor sensitivity.
- Use broad spectrum antibiotics while performing your evaluation.
- Delaying antibiotic therapy until the LP is completed is the most common error in ED management of meningitis. IV antibiotics given 2 hours or less before the LP will not affect the CSF results.
- Steroids should only be given before or accompanied with the first dose of antibiotics; giving them after may result in harm.
- Provide chemoprophylaxis to close contacts of those diagnosed with meningococcemia.