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Medicine General 269c5c77

A 13-year-old female presents with lethargy, fever, severe headache, and a stiff neck. On examination, a unilateral fixed, dilated pupil and papilledema is noted. Each of the following would be appropriate in initial management, EXCEPT:

A
Intubation and hyperventilation
B
Mannitol administered intravenously
C
Computerized tomography of the head
D
Lumbar puncture
High-Yield Explanation
This case most likely represents an adolescent with meningitis who has developed increased intracranial pressure. Intubation and hyperventilation is indicated immediately. Hyperventilation is the most appropriate immediate, non-surgical treatment of intracranial hypeension. By hyperventilating this patient you will decrease the pCO2 resulting in vasoconstriction of the central nervous system. Decreasing the pCO2 5 to 10 mm Hg will decrease intracranial pressure 25 to 30%. Administering antibiotics, preferably after blood cultures are obtained, is appropriate. Obtaining computerized tomography of the head may reveal intracranial lesions, which require additional therapy Ref: Ropper A.H., Samuels M.A. (2009). Chapter 2. Special Techniques for Neurologic Diagnosis. In A.H. Ropper, M.A. Samuels (Eds), Adams and Victor's Principles of Neurology, 9e.

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