Sun28November0440PM 2

A 2-year-old child has a suspected diagnosis of meningococcal infection. He has a heart rate of 136/minute, systolic blood pressure of 70 mmHg, SpO2 90% on room air, capillary refill time 5 seconds and is drowsy.

You should:

True / False

Administer ceftriaxone as soon as possible Correct

Immediately administer high flow oxygen Correct

Limit fluid resuscitation to 20 ml/kg to prevent cerebral oedema Correct

Administer dexamethasone 0.15 mg/kg if meningitis is confirmed Incorrect answer selected

Perform a lumbar puncture before giving the first dose of antibiotics to rule out meningitis Correct

Explanation

High flow oxygen should be administered and should be considered for urgent intubation and ventilation.

If there are signs of shock give an immediate IV or IO fluid bolus of 20 ml/kg sodium chloride 0.9% over 5-10 minutes. This should be repeated after reassessment. Fluids should not be restricted unless there is evidence of raised intracranial pressure or increased ADH secretion.

Ceftriaxone should be administered as soon as possible if the child is suspected of having meningococcal disease and this should precede a lumbar puncture.

Dexamethasone (0.15 mg/kg to a maximum dose of 10 mg, four times daily for 4 days)[12] should be given for suspected or confirmed bacterial meningitis as soon as possible following positive lumbar puncture criteria.

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Times answered: 298