How do I interpret WBCs in a traumatic tap?

Predicted CSF WBC per microL = CSF RBC x (peripheral blood WBC/peripheral blood RBC)

How do I interpret protein in a traumatic tap?

  • CSF bleeding results in approx. 1 extra mg of protein/dL per 1000 RBCs/microL

How do I tell the difference between viral and bacterial meningitis again?

  Viral Meningitis Bacterial Meningitis
CSF WBC (per microL) LOW                                                Usually<250,                                         almost always <2000 HIGH                          >1000
Differential Lymphocytic                                        (but may have early neutrophilic predominance) Neutrophilic
CSF Protein (mg/dL) LOW                                                       <150 HIGH                         >250
CSF glucose (mg/dL) HIGH                                            Usually >50% of serum glu LOW                     <45

Do I need to take chemoprophylaxis for meningitis exposure?

  • NOT indicated for brief healthcare interactions in the ED (<8 hours) unless DIRECT EXPOSURE TO RESPIRATORY SECRETIONS (as with suctioning or intubation).

Crap. I messily intubated a patient with bacterial meningitis. What do I take for prophylaxis??

  • Ciprofloxacin 500 mg PO x 1
  • Ceftriaxone 250 mg IM x 1
  • Rifampin 600 mg PO q12 x 2 days

Reference: UpToDate.