chbare Posted July 30, 2009 Share Posted July 30, 2009 (edited) When I first read the 1st message I immediately thought meningitis, yet was quickly turn in another direction when pt denies photophobia, stiff neck or a headache. The three classic signs of meningitis. Still kind of confused as to if this was the pt's diagnosis? The question was most likely not what is? According to my paramedic book Nancy Caroline's Emergency Care in the Streets. "The classic signs and symptoms of meningitis are the same for both viral and bacterial forms: sudden-onset fever, severe headache, stiff neck, photosensitivity, and a pink rash that becomes purple in color. The patient almost always experiences changes in mental status, ranging from apathy to delirium. Projectile vomiting is common..." How is it most likely meningitis when he seem to have most of the classic signs? I have no picture of the rash however the description in the book does not describe spots. I know patients do not always or even present in a text book manner, but he was the exact opposite. What do you think? PS I use yahoo image search and found some good meningitis rash that do resemble the one posted! Unfortunately, paramedic text books like to oversimplify conditions and simply give a "textbook" definition. However, anybody who appears rather ill with a petechial rash should have meningitis as a differential. This is why doctors have residencies and fellowships. It takes years to learn the difference between the textbook and reality. Ebola and all these other conditions may be considerations(Ebola & malaria are not associated with Fiji however.); however, do not let the zebra distract you from looking at the horse as well. Take care, chbare. Edited July 30, 2009 by chbare Link to comment Share on other sites More sharing options...
cosgrojo Posted July 30, 2009 Share Posted July 30, 2009 Unfortunately, paramedic text books like to oversimplify conditions and simply give a "textbook" definition. However, anybody who appears rather ill with a petechial rash should have meningitis as a differential. This is why doctors have residencies and fellowships. It takes years to learn the difference between the textbook and reality. Ebola and all these other conditions may be considerations(Ebola & malaria are not associated with Fiji however.); however, do not let the zebra distract you from looking at the horse as well. Take care, chbare. No argument here, but in my research on this subject since it was posed has shown any number of sources that state that it is highly unlikely that someone who presents without at least one of the triad of complaints has meningitis. So the zebra in this scenario looks more like a horse to me. Thanks Link to comment Share on other sites More sharing options...
speedygodzilla Posted July 30, 2009 Share Posted July 30, 2009 You would think that an infection to the lining of the brain would cause some kind of headache, stiff neck, are some sort of spinal pain or deficiency! Still people present very different than expected many times. Link to comment Share on other sites More sharing options...
Kiwiology Posted July 30, 2009 Author Share Posted July 30, 2009 From what I understand this is a case of meningococcemia which is a form of septicemia not meningitis which is why it's not producing the classic meningitis symptoms - headache, stiff neck, photophobia, N&V etc Link to comment Share on other sites More sharing options...
tniuqs Posted July 30, 2009 Share Posted July 30, 2009 From what I understand this is a case of meningococcemia which is a form of septicemia not meningitis which is why it's not producing the classic meningitis symptoms - headache, stiff neck, photophobia, N&V etc sorry in late on this thread. EZactly, once you actually observe meningococcemia "the rash" so to speak, you will never forget, btw meningal cocci is carried in the nose .... eeewww! I hate skin stuff it makes me scratch for weeks . cheers Link to comment Share on other sites More sharing options...
cosgrojo Posted July 30, 2009 Share Posted July 30, 2009 From what I understand this is a case of meningococcemia which is a form of septicemia not meningitis which is why it's not producing the classic meningitis symptoms - headache, stiff neck, photophobia, N&V etc Well then... he's screwed. From the information we would be able to attain in the field, it would be highly unlikely to accurately guess this one. Unless like chbare, you somehow know Fijiian viral and bacterial common infection rates. Cuz' I certainly don't. Everything I know about this subject I have researched in last two days. Dude... once again... you frighten me. Link to comment Share on other sites More sharing options...
Kiwiology Posted July 30, 2009 Author Share Posted July 30, 2009 (edited) The travel to Fiji and mozzie bites are probably unrelated; although it's hard to say. So I'm told. As I read this I saw ... mainly asymptomatic patient with normal vitals signs, sore throat/feeling like he has the flu and recently got back from vacation. I was ready to chalk it up to some infection, call him non transport and recommend he go see his family doctor, get back in the truck and drive to the station to lie down on the couch. Then I looked at the cap refill of > 3 seconds and all those nasty, ugly purpura and I thought something was a bit odd ... I honestly had no idea what to call it ecept probably early consepmatory shock so OK might have to transport him .... couch is not very comfortable anyway. Edited July 30, 2009 by kiwimedic Link to comment Share on other sites More sharing options...
tniuqs Posted July 30, 2009 Share Posted July 30, 2009 petechia rash, most likely malaria, but could be any infection (or blood disorder from an infection) from a third world country ---- put on the yellow suit, mask, gloves --- ABCs, IV, get to hospital where antibiotics could be started --- decon the hell out of your truck. Dont lick the open sores. Yes no licking of anything Ebola is limited to Africa ... thank god ... it is hemmoragic in appearance but mucosal membranes are first affected (I worked Medivac with a Red Cross RN that had spent time in Rwanda) the progression of the disease is very fast from 2 days to 21 ... typicall in 4 to 6 days they are ded ... remote areas and whole villages affected. RUN AWAY to kiwi medic couch. .... ok that was funny. Malaria ... no rash with malaria in vast majority of cases, the dignostic tools are a simple thermometer and observation of the shaking/chills, the time frames of such, one can clinically assess for even the type of malaria ... if I remember 4 types .. been a while since I have been off NA continent. Travel abroad where Malaria is KNOWN to have cases (try the WHO website or Travel Canada for advisories)... take doxycycline to thwart malaria. cheers Link to comment Share on other sites More sharing options...
fireflymedic Posted July 30, 2009 Share Posted July 30, 2009 I had two thoughts initially though I'm late in on the scenario - sepsis - had a patient not long ago that resembled this so it was fresh in my mind had both gram negative and positive bacteria going on - self contamination of picc line. My other thought was rocky mountain spotted fever - I know not prevalent in your area kiwi, but who knows where you dug the scenario up from? Could have been around here. This area is prevalent with ticks so lyme disease and rocky mountain spotted fever produces a very similar rash with comparable symptoms. It's been seen more than a few times. But it's a great scenario. There have been a few cases I've heard of pts having meningitis and having very little symptoms, but this guy is certainly in trouble at this point. As far as the reference to nancy caroline's book - much of it is outdated or flat wrong. Be careful what you follow within that book. Brady is a much better resource. Link to comment Share on other sites More sharing options...
chbare Posted July 30, 2009 Share Posted July 30, 2009 Hehe, the nasty Caroline book. It was a dissapointment, and very polarizing. On one end, I loved the fact that it had a pathophysiology chapter, then total dissapointment with other chapters such as the cardiac section. As a side note, I really am fairly dull when compared to other tools in the shed. However, my Googlefu technique is so strong, it creates the illusion of intelligence. Take care, chbare. Link to comment Share on other sites More sharing options...
Recommended Posts