title: Emergency Neurologic Life Support: Meningitis and Encephalitis.
abstract: Bacterial meningitis and viral encephalitis, particularly herpes simplex encephalitis, 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 and urgent treatment of bacterial meningitis and encephalitis. Appropriate imaging, spinal fluid analysis, and early empiric treatment is discussed. Though uncommon in its full form, the typical clinical triad of headache, fever, and neck stiffness should alert the clinical practitioner to the possibility of a central nervous system infection. 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, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA. david.gaieski@uphs.upenn.edu.
authors.forename: David F
authors.initials: DF
authors.lastname: Gaieski
authors.affiliation: Division of Neurocritical Care, Department of Neurology, University of Virginia, Charlottesville, VA, USA. brn3a@cms.mail.virginia.edu.
authors.forename: Barnett R
authors.initials: BR
authors.lastname: Nathan
authors.affiliation: Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Nicole F
authors.initials: NF
authors.lastname: O'Brien
mesh_terms: D004638:Emergency Treatment / Q000379:methods*; D004660:Encephalitis / Q000628:therapy*; D006801:Humans; D008020:Life Support Care / Q000379:methods*; D008581:Meningitis / Q000628:therapy*; D009462:Neurology / Q000379:methods*
keywords: Central nervous system infection; Critical care; Emergency; Encephalitis; Meningitis; Neurocritical care