B. Physical examination: Note for Meningeal signs: Altered mental status, seizures, nuchal rigidity, a bulging anterior fontanel, Kernigís
sign (resistance to extension of the leg) and Brudzinskiís sign (the knees flex in response to rapid flexion of the neck). Note for signs of increased intracranial tension (ICT): A fundus examination ismandatory to detect
Papilledema in all cases of suspected meningitis prior to a lumbar puncture. The other signs of ICT include hypertension and bradycardia. Note for signs of Shock: Evaluate the hydration status and note for mottling of the skin, slow capillary refill,
increased pulse rate, and decreased blood pressure. Note for focal neurological deficits: Document focal deficits, weakness, or ataxia, Measure head circumference. Note for clues to the probable organism causing meningitis: Petechiae or purpura (meningococcemia), bone and joint infection (H.influenza), otitis media (H. influenza), indwelling lines (Staphylococcus).
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