A 22-year-old college student is brought to the emergency department by his roommates because he is unarousable. He had complained of a severe headache and fever for the past 24 hours. Vital signs show temperature (), blood pressure 80/40 mm Hg, pulse 135/min, and respirations 28/min. Oxygen saturation is 88% on room air. Physical examination reveals a petechial rash on the lower extremities and nuchal rigidity. The patient only withdraws to pain and does not open his eyes or make any sounds (Glasgow Coma Scale score of 6).
Arrange the following management steps in the most appropriate sequential order for this patient's initial stabilization and diagnostic workup.
- 1Perform endotracheal intubation
- 2Administer a rapid intravenous crystalloid bolus
- 3Obtain peripheral blood cultures
- 4Administer empiric intravenous antibiotics
- 5Obtain a non-contrast computed tomography of the head
Answer
The correct sequence is: Perform endotracheal intubation, then Administer a rapid intravenous crystalloid bolus, then Obtain peripheral blood cultures, then Administer empiric intravenous antibiotics, and finally Obtain a non-contrast computed tomography of the head.
The correct sequence strictly follows the algorithms for acute resuscitation and suspected bacterial meningitis. Endotracheal intubation (Airway) is required first due to the patient's low GCS and hypoxia. This is immediately followed by fluid resuscitation for septic shock (Circulation). Once the patient is stabilized, blood cultures are drawn before administering empiric antibiotics to ensure maximum diagnostic yield. Finally, because the patient has altered mental status, a head CT must be performed before attempting a lumbar puncture.
Step-by-Step Solution
Key Concept
Prioritization of ABCs (Airway, Breathing, Circulation) followed by appropriate test sequencing in septic shock and suspected bacterial meningitis.