The nurse and Tech begin to: Establish an IV, place the patient on oxygen, telemetry monitor, Undress the patient, get a fresh set of vital signs, and draw blood.

What is an essential order to request as you initiate your exam?

Before you have a chance to evaluate the patients ABC’s, he stops seizing and is post ictal.

VS: BP: 140/90. HR 130 (ST on the monitor), RR=26, Sat 96%

HEENT: PERRL, roving eye movement, otherwise neg.

Heart Tachy, No Murmer, rub or gallop

Lungs: Clear bilaterally

Abd: soft, appears non-tender, no guarding or rigidity.

Ext: no edema or rashes (although he is African American and has a dark skin tone)

Neuro: He keeps his eyes closed (but opens them to pain), He screams ‘No Joey NO’ when given painful stimuli, and withdraws to painful stimuli. He moves all extremities the same, and doesn’t appear to have any focality to his motor or sensory exam.

2. What is his GCS? Which portion of the physical exam are you missing?


3. You decide he needs an LP. Do you need to order a CT first? WHat criteria predicts need for CT before LP for possible menigititis in Adults?


4. If you decide to treat him for Meningitis, does he need steroids?

 

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