CASE SCENARIO
Noah is a 6 yo brought in by ambulance to ED at 2100hrsfollowing a seizure which lasted for 30 seconds.
Parents state that Noah complained of a headache and stiffneck then vomited after being given a dose of paracetamol.He has been lethargic all day, has a fever and is turning hishead inwardly to avoid the bright lights.
Noah is flushed and irritable.
Noah is being managed for bacterial meningitis andintravenous antibiotics (cefotaxime) have now commenced.
Past Medical History: Nil significant
Nil known allergies.
Childhood vaccinations up to date.
ASSESSMENT
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 andclammy to touch.
Disability - GCS-13 E3V4M6, opening eyes to speech not oriented to time, place or person, PEARL-4mm- significantly photophobic on examination
Exposure - Febrile 39.5 degrees Celsius. Unable to flex neck and lift head. Cool extremities. Significantswelling 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. Looseinvoluntary bowel motion.
Glucose - BGL-7.8 mmol/L
INVESTIGATIONS
Urine analysis: Nil abnormalities detected. Urine very concentrated
Bloods- WCC- 22.4, CRP- 96
Lumbar puncture- CSF analysis- opalescent fluid, 15 000/cmm with 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 bacterialmeningitis.
A MET call was activated at 2200hrs.
QUESTIONS
Q1: Discuss the pathophysiological link between the multiple disease conditions that thedeteriorating patient has and the clinical presentation.
(Marking criteria: Critically and accurately discuss TWO diagnostic results and relates to theunderlying pathophysiology)
Q2: Discuss the pharmacological actions of TWO drugs that could be used in the managementof this patient’s acute deterioration.
(Marking criteria: Critically and accurately analyse and discuss the pharmacological actions ofTWO drugs that could be used to manage the deteriorating patient and relate to the underlyingpathophysiology)