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The patient with acute neurological problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Severe headache, fever, nausea, vomiting and feeling unwell are early symptoms of meningitis; hyperpyrexia is common. Neck stiffness is also an early sign and may be associated with lethargy and confusion. Lethargy can quickly progress to unconsciousness. Photophobia and non-blanching rash are also common. Other signs may also include physical signs such as Brudzinski’s sign (pain when the neck, hips and knees flex simultaneously) and Kernig’s sign (with the patient supine, the knee is flexed and then straightened; straightening causes acute pain).
Infectious diseases and tropical medicine
Published in Shibley Rahman, Avinash Sharma, MRCP Part 2 Best of Five Practice Questions, 2018
Shibley Rahman, Avinash Sharma
A 19-year-old student was admitted with headache, photophobia and malaise for one day. She had no previous medical history and was not on any medication. On examination, she was drowsy and had a temperature of 38.5°C, pulse 110 regular, and blood pressure 90/55. JVP was +1 cm, and there was no focal neurological deficit. There was a non-blanching rash on her legs.
General Paediatrics
Published in Timothy G Barrett, Anthony D Lander, Vin Diwakar, A Paediatric Vade-Mecum, 2002
Timothy G Barrett, Anthony D Lander, Vin Diwakar
A wide variety of conditions can result in rashes, and the typical morphology and distribution of some of the commoner types is shown in Table 7.2. Failure to blanch on pressure indicates extravasation of red cells, and meningococcal disease must be excluded. Meningococcaemia does not follow a relapsing/remitting course, and patients decline rapidly and progressively.Patients with a florid petechial rash secondary to meningococcaemia will be extremely sick.If any doubt exists as to whether a non-blanching rash is meningococcal in origin, it should be treated as such.
Why Does Sepsis Kill So Many Children?
Published in Comprehensive Child and Adolescent Nursing, 2023
With its warning “THINK Could this be Sepsis,” the pediatric sepsis six protocol algorithm helps the nurse to recognize a child at risk of developing sepsis and this includes a core temperature of less than 36°C or above 38.5°C, tachycardia, altered mental state, and/or prolonged capillary refill rate which is more than 2 seconds. The algorithm also identifies a number of red flag warnings such as lowered blood pressure and a non-blanching rash where any one of the red flags leads to the implementation of the sepsis six treatment strategy within 1 hour (In clinical practice, this is often referred to as the “golden hour” after diagnosis.), namely Give high flow oxygenObtain intravenous/intraosseous access and take blood testsGive intravenous or intraosseous antibioticsConsider fluid resuscitationInvolve senior clinicians earlyConsider inotropic support early
Increasing knowledge and inclusivity – encompassing BAME in medical education
Published in Medical Teacher, 2021
Traditional white euro-centric content in medical teaching results in medical students whom are often unprepared and ill-equipped in recognising signs of certain diseases in black and minority ethnic (BAME) patients. Conditions that do not present in a similar manner to white patients or perhaps may be less clinically obvious in darker-skin risk being misdiagnosed or missed altogether. This is a pertinent concern in many medical conditions such as Addison’s Disease, Varicella Zoster Virus and Kawasaki’s disease, to name a few. Classic clinical signs such as ‘erythematous’, ‘rubor’, ‘pallor’ and ‘blue-tint cyanosis’ cannot always be typically noted on BAME patients and medical students are often not taught the difference explicitly. It is important that BAME patients are acknowledged consistently throughout the medical curriculum and not just in highly specific case studies such as sickle-cell disease, HIV and sarcoidosis, often which are stereotyped as explained by Moskowitz et al. (2012). A particularly important example is the meningococcal non-blanching rash, which is usually less visible in dark-skinned people. Often taught as a classic diagnostic marker of meningitis, being unable to identify this sign can lead to diagnostic delays in dark-skinned people, which could result in fatal consequences.