EMCrit Podcast 28 – Severe CNS Infections - a podcast by Scott D. Weingart, MD FCCM
from 2010-07-13T20:25:02
Severe CNS Infections are time dependent diagnoses! You must have a high index of suspicion, a good plan for your work-up, and rapid provision of treatment. After seeing a severely ill meningitis patient, I figured I would do a podcast on some tips and pearls on this topic.
When to Suspect
Here is the article I mentioned on establishing pretest prob:
http://pmid.us/15509818
What Antibiotics
Ceftriaxone 2g as empiric therapy in any suspected meningitis patient
If high risk or LP results are positive, also give
* Vancomycin 1 G
* Ampicillin 2g if age > 50 y/o
* Acyclovir 10 mg/kg if high RBC count, obtundation, seizures, or focal neurologic deficit
* Dexamethasone 10 mg
* Cefepime or Imipenem if hospitalized or neurosurgery patient
listen to the podcast for more and see the EMCrit chapter for more.
photo by Lapoland
Update:
Def. give Dex. (PMID: 12432041)
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