Read the following Emergency Department Record.

Answer the questions on the Question Sheet and submit.

Emergency Department Record

Patient: James Doe

DOB: 5/31/2001

MR#: 056221

Chief Complaint

Nausea, vomiting, headache

Hx of Present Illness

This 17 year old male was seen by his PCP earlier today following several days of nausea, vomiting, headache, and elevated temperature with lethargy. He was sent to the Emergency Department by the PCP for further evaluation and a lumbar puncture (LP) to rule out meningitis.

Allergies: None known

Physical Examination

PE reveals a well-developed and nourished lethargic young man. BP is 130/80, pulse 93, respirations 27, and temperature 102. There is marked stiffness of the neck with some rigidity and positive Babinski reflex and Kernigs sign.

Cardiac exam was normal for rate and rhythm with no murmurs. Lungs clear bilaterally.

During the exam the patient became increasingly lethargic with little response to stimuli.

LABS

LP revealed gram negative cocci. CBC also showed some bacteria.

Impression

Acute bacterial meningitis

Plan

Patient was transferred to the Intensive Care Unit and

referred to the Neurology Service for hospital inpatient admission and Antibiotic therapy.