Noah is6 yearsoldbroughtin by ambulance to ED at 2100hrs following a seizure which lasted for 30 seconds. Parents state

[answerhappygod]

Noah is6 yearsoldbroughtin by ambulance to ED at 2100hrs
following a seizure which lasted for 30 seconds. Parents state that
Noah complained of a headache and stiff neck then vomited after
being given a dose of paracetamol. He has been lethargic all day,
has a fever and is turning his head inwardly to avoid the bright
lights.Noah is flushed and irritable.Noah is being managed for
bacterial meningitis and intravenous antibiotics (cefotaxime) have
now commenced.•Past MedicalHistory: Nil significant•Nil known
allergies.
Childhood vaccinations up to date.
ASSESSMENT
Airway. - Patent
Breathing. - Spontaneous, RR-12 mt, SPO2-98% RA, air-entry
equal
Circulation- Pale in face, BP- 75/57 mmHg, HR- 145/mt but weak,
capillary refill 3 seconds, cool and clammy to touch.
Disability - GCS-13 E3V4M6, opening eyes to speech not oriented
to time, place or person, PEARL- 4mm-significantly photophobicon
examination
Exposure - Febrile 39.5 degrees Celsius. Unable to flex neck and
lift head. Cool extremities. Significant swelling to lips and
blanching rash to left arm. IVC 22g via left cubital fossa.
Fluids - Unable to tolerate oral fluids, NBM for now. IV
cefotaxime in progress. Oliguric. Loose involuntary bowel
motion.
Glucose - BGL-7.8 mmol/L
INVESTIGATIONS
•Urine analysis: Nil abnormalities detected. Urine very
concentrated•Bloods- WCC- 22.4, CRP- 96•Lumbar puncture- CSF
analysis- opalescent fluid,15 000/cmmwith 88% neutrophils, 8%
lymphocytes; glucose of 2 mg/dL and protein of 15 mg/dL. CSF Gram
stain positive.•Additional information: CSF cultures
–Streptococcus•Diagnosis: Anaphylactic shock associated with the
management of bacterial meningitis.
A MET call was activated at 2200hrs.
Question 4 DiscussTWO diagnostic results and relate it to
the underlying pathophysiology.