Investigations | Right Decisions

Correct dehydration. Perform blood tests.

Blood tests:

If limited volume prioritise blood gas, glucose, lactate, electrolytes, FBC and clotting.
Also - blood culture, CRP, U & E/LFT, whole-blood (EDTA specimen) for PCR.
NB. initial CRP may be normal

Are there any of the following contraindications to lumbar puncture? Discuss with senior if uncertain. (NB. Perform delayed LP in infants with suspected bacterial meningitis when contraindications no longer present.)

Shock/coma

Convulsion in past 30 minutes.

Coagulation abnormalities: clotting study results (if obtained) outside normal range or platelet count below 100 x 109/L or on Anticoagulant therapy

Local superficial infection at LP site.

Respiratory insufficiency.

Other Clinical or radiological signs of raised intracranial pressure (RICP): reduced (GCS ≤8) or fluctuating level of consciousness or relative bradycardia and hypertension or focal neurological signs or abnormal posture or posturing or unequal, dilated or poorly responsive pupils or papilloedema (late sign) or abnormal ‘doll’s eye’ movements.

None of the above.

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