When to place an N95 mask on your Pt given meningitus Sx?

[berkeman]

So I was working a part time EMT shift yesterday at a very large charity event, and one of the volunteers asked for help with Sx of lightheadedness and nausea. It had turned into a a warm day, so heat exhaustion was a possibility.

Further assessment -- she reported a fever for two days, a headache, a sore throat, and neck pain. I asked her to lean her head forward and tell me how that felt, and she replied that it hurt a lot when she did that. Crap.

So should I have asked her to put an N95 mask from my EMT jump kit on at that point? I reported the Sx to my medic supervisor and our RN supervisor, but the RN was pretty relaxed about our BSI response to this Pt. Did he see something that I didn't see?

http://www.cdc.gov/meningitis/

 

[Drakkith]

I'm not familiar with medical terminology at all. Are you worried about catching meningitis, or that she might have passed it on to others, or what?

lightheartedness and nausea

I assume you mean lightheadedness? (look at the red squiggly underneath that word!)

 

[berkeman]

I'm not familiar with medical terminology at all. Are you worried about catching meningitis, or that she might have passed it on to others, or what?

Yeah, one form of meningitis is very contagious, and another is not so much, I think. From the body language of the nurse, he seemed to think this was the less contagious type for some reason.

you mean lightheadedness?

Yeah, it got changed to lightheartedness for some reason... Thanks.

 

[berkeman]

I'm not familiar with medical terminology

Sorry:

Pt -- Patient
Sx -- Symptoms
RN -- Registered Nurse
BSI -- Body Substance Isolation (gloves, mask, glasses, etc.)

 

[Drakkith]

Don't kiss me, I might catch the meningitis!

 

[berkeman]

Oops, eek! Fixed my misfire...

 

[256bits]

Yeah, one form of meningitis is very contagious, and another is not so much, I think. From the body language of the nurse, he seemed to think this was the less contagious type for some reason.

Yeah, it got changed to lightheartedness for some reason... Thanks.

Why meningitis?
Why not influenza?

 

[berkeman]

Why meningitis?
Why not influenza?

It could be the flu with other things causing the neck and throat soreness, and hopefully that's all it was. But especially the pain in the back of the neck, made worse by tilting her head forward, was a symptom of meningitis. She also had no other aches and pains or chills for the two days since the fever started. Anyway, it's up to the docs to diagnose what she has. I'm just curious if anybody has had experience around patients with meningitis symptoms, and what kind of precautions they took and when.

 

[256bits]

It could be the flu with other things causing the neck and throat soreness, and hopefully that's all it was. But especially the pain in the back of the neck, made worse by tilting her head forward, was a symptom of meningitis. She also had no other aches and pains or chills for the two days since the fever started. Anyway, it's up to the docs to diagnose what she has. I'm just curious if anybody has had experience around patients with meningitis symptoms, and what kind of precautions they took and when.

OK. So, one can piece together the clues for a direction of a diagnosis.
This was in my mind for the asking. The parents mis-diagnosed.
http://www.msn.com/en-ca/news/canada/jury-finds-couple-guilty-in-son%E2%80%99s-death-from-meningitis/ar-BBsiWII?li=AAggNb9&OCID=ansmsnnews11
They thought it was just flu or croup - kid became too stiff to bend his limbs.
Nurse friend told them it was probably meningitis.
They used a naturopath remedy of " hot peppers, garlic, onions and horseradish".

Naturopath?? Path to nature is dying.

I hope this doesn't throw your thread off kilter, but it seems that the parents, nurse friend ( she should have reported to child agencies yes/ no ), naturopath let the kid down.

You seem to have picked up, and acted on, symptoms right away.

 

[berkeman]

That's sad.

 

[gjonesy]

I hope this doesn't throw your thread off kilter, but it seems that the parents, nurse friend ( she should have reported to child agencies yes/ no ), naturopath let the kid down.

YES absolutely! In my state (NC) she could probably be sued, All first responders have a duty to act. Her being an advanced first responder if she recognized the child as being in a life threating situation I would assume "the duty to act" would apply. If you are a FR and you act, even if your action doesn't save a life you can't be held liable due to good Samaritan laws. But if you do nothing (I don't know if warning the parents would be considered as something) as far as duty to act. But you can be held liable just like any doctor or firefighter or cop for failing to do your job. Her's obviously is to save and preserve life.

So should I have asked her to put an N95 mask from my EMT jump kit on at that point? I reported the Sx to my medic supervisor and our RN supervisor, but the RN was pretty relaxed about our BSI response to this Pt. Did he see something that I didn't see?

Not sure, we only use the N95 if we suspect active TB, BUT IMHO I think at the very least a mask should be part of UPM dealing with any first response. I had a prisoner drop out and seize, his mouth got busted and the back of his head was split wide open. He was in the bathroom and the only thing I had was my glove pouch. I put gloves on and held the back of his head so when he convulsed my hand would hit the cement instead of the back of his head. Any how he forcefully exhaled and shot a mist of blood right in my face. After that I put a face mask in my kit. Still didn't stop me from being exposed to blood but that's a different story all together.

@berkeman I respect you a lot for what you do and as a mentor here. "should I have asked her to put an N95 mask from my EMT jump kit" personally I think you should use your best judgment. I wouldn't worry about protocol, patient sensitivity, or any other standing order you may have. Like my senior trainer used to say, if its your life and health, do your job but keep you safe. Deal with the legality of it when you get to court. If your dead you can not defend an action that might have saved your life. That applies to shoot don't shoot, hazardous condition, or first response. P.M. me and I'll tell you my biggest scare and the reason I sit behind a desk now.

 

[Laroxe]

My general feeling is its not really worth worrying about. It seems that there were several more likely explanations for her symptoms, you reported your concerns and it would have been easy to advise them to get checked out. You could also see how they responded to a rest and some cold drinks.
If this turned out to be meningitis you would be a known contact and would be given prophylactic antibiotics, whether you had a mask on or not.

 

[Evo]

This was a 4 year old thread from 2016 that accidentally got resurrected, it is closed to avoid spam.