& Headaches

What is meningitis?  Swelling (-itis) of the lining surrounding the brain & spinal cord (meninges)  Life-threatening condition  ~135,000 deaths each year (globally)  Usually affects kids & young people (but not always)

What is meningitis?  Usually viral or bacterial (bacterial more serious)  Septicaemia is the poisoning of the blood which may occur alongside meningitis  Affects 3,200 in UK every year

What is meningitis?  Even when the disease is diagnosed early and adequate treatment is started, 5% to 10% of patients die, typically within 24 to 48 hours after the onset of symptoms. Left untreated, up to 50% of cases may die. Bacterial meningitis may also result in brain damage, hearing loss or a learning disability in 10% to 20% of survivors.

It’s up to us…  Need to recognise symptoms early and get the patient to hospital urgently

Symptoms?  What are the early symptoms?  Rash? NO  Fever  Vomitting  Headache  ‘Feeling unwell’

Symptoms?  What else could there be?  Muscle/joint/limb pain  Cold hands & feet  Pale or blotchy skin (+ blue lips)

Symptoms?  What are the late symptoms?  Drowsiness  Confusion  Rapid R.R. / S.O.B  Stiff neck  Photophobia  Rash  Seizures

Rash  Not always present!  Red & blotchy  Could be anywhere  What’s special about it?

Rash – Tumbler test  Does not fade or change colour when you place a glass against it = suspect meningitis

Assessment & Management  Primary survey  Airway – swollen? Noisy? Etc.  Breathing – fast or slow?  Circulation – poor circulation?  Dysfunction – may be affected  Expose – if there’s a rash, find it!  Tumbler test  Obs (response, pulse, resp rate, cap refil)  SAMPLE (esp history of symptoms)  999 early!!

Headaches  What else could cause headaches?

Headaches  Tension headaches  Migraines  CVA (stroke) & TIA  Raised intracranial pressure (head injury)  Sinusitis etc.

Migraines  True or false – Migraines can come with…  Intolerance of light/sound?  Vomiting?  Pins and needles?  Patients usually know they get migraines  Often preceded by an ‘aura’

Raised ICP  Increased pressure within skull  Caused by tumours, abscesses & haematomas  Need to go to hospital  S&S:  Generalised headache  Gradual increase in severity  Vomiting  Temporary visual loss

CVA (Stroke)  Caused by blood clot or bleed in the brain  FAST positive?  S&S (Sudden…):  Weakness (FAST)  Visual disturbance  Severe headache  Dizziness  Confusion  What is a T.I.A?

Headache Assessment  ABCs  Obs  S – other symptoms?  Nausea, vomiting, one-sided weakness, confusion, drowsiness, loss of consciousness etc.  FAST test!!  Allergies  Medications  Past medical history  Hyptertension = higher risk of CVA (stroke)  Susceptible to migraines? Family history?  Last meal  Event history  Previous head injury? (days before?)

Pain Assessment  (In addition to primary survey, obs, SAMPLE)  O  P  Q  R  S  T

Seizures (‘Fits’)  There are many types and causes (inc Epilepsy and increased temperature)  Management:  Remove dangerous/ harmful objects  DO NOT restrain the patient  TIME the fit  If first fit or >5mins call 999  Recovery position after the fit has subsided  Cover the patient with a blanket in case the wet themselves (DIGNITY)

More Info 