title: Emergency neurologic life support: meningitis and encephalitis.
abstract: Bacterial meningitis and viral encephalitis, particularly herpes simplex encephalitis (HSE), are severe neurological infections that, if not treated promptly and effectively, lead to poor neurological outcome or death. Because treatment is more effective if given early, the topic of meningitis and encephalitis was chosen as an Emergency Neurological Life Support protocol. This protocol provides a practical approach to recognition of and urgent treatment for bacterial meningitis and HSE, including imaging and spinal fluid analysis, and discusses the choice of empirical treatments until the cause of infection is determined. Though uncommon in its full form, the typical clinical triad of headache, fever, and neck stiffness should alert the clinical practitioner to the syndromes. Early attention to the airway and maintaining normotension is crucial in treatment of these patients, as is rapid treatment with anti-infectives and, in some cases, corticosteroids.
authors.affiliation: Department of Emergency Medicine and Center for Resuscitation Science, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA. gaieskid@uphs.upenn.edu
authors.forename: David F
authors.initials: DF
authors.lastname: Gaieski
authors.forename: Barnett R
authors.initials: BR
authors.lastname: Nathan
authors.forename: Scott D
authors.initials: SD
authors.lastname: Weingart
authors.forename: Wade S
authors.initials: WS
authors.lastname: Smith
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000998:Antiviral Agents; D002555:Cerebrospinal Fluid / Q000166:cytology; D004632:Emergency Medical Services / Q000379:methods; D020803:Encephalitis, Herpes Simplex / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000188:drug therapy; D018792:Encephalitis, Viral / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000188:drug therapy; D017410:Practice Guidelines as Topic; D013129:Spinal Puncture
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000998:Antiviral Agents