Noah is6 yearsoldbroughtin by ambulance to ED at 2100hrs following a seizure which lasted for 30 seconds. Parents state that Noah complained of a headache and stiff neck then vomited after being given a dose of paracetamol. He has been lethargic all day, has a fever and is turning his head inwardly to avoid the bright lights.Noah is flushed and irritable.Noah is being managed for bacterial meningitis and intravenous antibiotics (cefotaxime) have now commenced.•Past MedicalHistory: Nil significant•Nil known allergies.
Childhood vaccinations up to date.
Airway. - Patent
Breathing. - Spontaneous, RR-12 mt, SPO2-98% RA, air-entry equal
Circulation- Pale in face, BP- 75/57 mmHg, HR- 145/mt but weak, capillary refill 3 seconds, cool and clammy to touch.
Disability - GCS-13 E3V4M6, opening eyes to speech not oriented to time, place or person, PEARL- 4mm-significantly photophobicon examination
Exposure - Febrile 39.5 degrees Celsius. Unable to flex neck and lift head. Cool extremities. Significant swelling to lips and blanching rash to left arm. IVC 22g via left cubital fossa.
Fluids - Unable to tolerate oral fluids, NBM for now. IV cefotaxime in progress. Oliguric. Loose involuntary bowel motion.
Glucose - BGL-7.8 mmol/L
•Urine analysis: Nil abnormalities detected. Urine very concentrated•Bloods- WCC- 22.4, CRP- 96•Lumbar puncture- CSF analysis- opalescent fluid,15 000/cmmwith 88% neutrophils, 8% lymphocytes; glucose of 2 mg/dL and protein of 15 mg/dL. CSF Gram stain positive.•Additional information: CSF cultures –Streptococcus•Diagnosis: Anaphylactic shock associated with the management of bacterial meningitis.
A MET call was activated at 2200hrs.
The presentation should answerallthe questions below.
Q1.Explain in an oral presentationthe high priority clinical manifestationsthat have resulted in the escalation to MET call using a primary survey format (A-G).
Q2.Describethe pathophysiological linkto the identified high priority clinical manifestations and the disease conditions that the patient has.
Q3.Discuss the pathophysiological link betweenthe multiple disease conditionsthat the deteriorating patient has and the clinical presentation.
Q4.DiscussTWO diagnostic resultsand relate it to the underlying pathophysiology.Q5.ExplainTHREE high priority interventionsyou will do to improve the patient’s
Q6.Discuss the pharmacological actions ofTWO drugsthat could be used in the management of this patient’s acute deterioration.