A 45-year-old man arrives at the emergency department complaining of sudden, severe headache, fever, nausea, and confusion. Vital signs are: temperature 39.2 °C (102.6 °F), heart rate 112 beats/min, blood pressure 132/78 mm Hg, respiratory rate 24/min, and SpO₂ 98 % on room air. Examination reveals nuchal rigidity; passive neck flexion produces involuntary flexion of the knees and hips (positive Brudzinski sign). Two sets of blood cultures are obtained at the bedside. What is the single most important next intervention to reduce this patient's morbidity and mortality?
Elevate the head of the bed to 30 degrees
Prepare the patient for immediate lumbar puncture
Begin empiric broad-spectrum intravenous antibiotics without delay
Obtain an emergent non-contrast head CT before giving any therapy
Empiric broad-spectrum IV antibiotics should be started immediately after blood cultures when bacterial meningitis is suspected. Multiple guidelines (e.g., IDSA, European, and national recommendations) emphasize initiating treatment within one hour of ED arrival; delays of more than two to three hours significantly increase mortality and neurologic sequelae. Elevating the head of the bed can aid venous drainage, and imaging or lumbar puncture may be necessary for diagnosis, but none of these measures supersede the time-critical need for early antimicrobial therapy.
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Neurological Emergencies
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