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Ah, the first Conference of the academic year. The new faces, with their bubbling enthisasm, suddenly confronted with the annual reading of the policies & procedures manual… why, it’s enough to give anyone a headache and photophobia. Which is why it’s so timely that we review meningitis, with a focus on some physical exam skills that can (but may not) help guide your diagnosis.

Tim reviewed a paper by Thomas et al out of Yale, published in Clinical Infectious Diseases (2002;Vol 35 July 1, pp46-52) called “The Diagnostic Accuracy of Kernig’s Sign, Bruzinski’s Sign, and Nuchal Rigidity in Adults with Suspected Meningitis.” Here’s his CAT sheet.

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I gave a talk last week on the workup of nonsevere sepsis that referenced a bunch of little papers, and a few big ones… We’ll leave the discussion of the landmark 2001 EGDT severe-sepsis talk for another time (sigh). Right now I just wanted to go over an Annals paper (AEM Vol 45, No 5, May ‘05) by Shapiro et al from Beth-Israel Deaconess, about lactate in the ED. They were looking at the value of ED serum lactate levels as a predictor of later mortality – echoing studies on ICU lactate and mortality for patients with septic shock, burns, or trauma.

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