pediatrics emergency

[3abeer]

A4 yr old , was reffered to you, in the PHC( primary health care centre), by his caregiver in the KG, as he developed fever & skin rash so suddenly over the last 2 hrs.
On examination the child looked drowsy, with skin rash ,described as ( non- blanching red spots). He has also neck stiffness.
1- What?s your 1st clinical impression ?
2- What should you do before reffering him to the hospital?
3- The teacher is asking about he prophylactic measures that should be taken in the KG , what would you say?
4- Suppose, you are working in the hospital, & you did an LP, on a child whose suspected to have meningitis( another patient), & the LP was traumatic,( mixed with a lot f blood), & the family are refusing to repeat the LP, how would you calculate the number of WBCs in the traumatic LP you got?

ALL THE BEST

[3abeer]

I THINK THIS IS AN EASY Q
WHERE RU GUYS 

[dr_dina]

dr. 3beer
plz we want to know the answer.
is it meningitis?

[3abeer]

dear colleagues
this picture is typical 4 meningeococcal meningitis, 

now, i think it should be easy 2 get the other answers
waiting 4 that 

[3abeer]

well guys , here are the answers

1- you should give the kid iv penicillin before referring him to the hospital, remember DONT WAIT

2- kids in the KG should receive rifampin as prophlaxis

3- about the lp you should know the traumatic LP formula , i dont remember that now, but i will get it inshalla as soon as i can

any queries 

[dr_b.e.s.m]

4- Suppose, you are working in the hospital, & you did an LP, on a child whose suspected to have meningitis( another patient), & the LP was traumatic,( mixed with a lot f blood), & the family are refusing to repeat the LP, how would you calculate the number of WBCs in the traumatic LP you got?

I read this in emedicine:

If the fluid appears to be bloody, several specimens should be collected. If the blood clears in successive tubes then the blood, at least in part, was traumatic in origin. Unfortunately, this sign is neither specific nor sensitive, as in some traumatic taps the amount of blood increases in subsequent tubes.

But you still can calculate the WBC count:

A traumatic tap will, of course, introduce both WBCs and RBCs into the CSF. An approximation of 1 WBC per 1000 RBCs can be made, although a repeat tap is preferable.? [If the peripheral WBC count is not abnormally low or high, a good rule of thumb is to subtract one WBC for every 500 to 1500 RBCs if a traumatic tap is suspected in order to better evaluate the significance of the observed WBC concentration in the CSF.]

A more accurate method is to calculate the predicted CSF WBC count from the following formula:

? ?

Predicted CSF WBC count/?L = CSF RBC count x (peripheral blood WBC count ? peripheral blood RBC count)

[3abeer]

DEAR BAHA2:
NO MORE 2 BE SAID, THIS IS THE EQUATION I WAS TRYING 2 MEMORIZE