Usefulness of Kernig and Brudzinski Signs in Diagnosing Meningitis

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.

Lactate in the ED, Death on the Floors

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.