- If you think CT will show a cause for the headache, do a CT
- If a CT is indicated for other reasons (depressed conscious level, focal neurology), do a CT
- If a GCS 15 patient is to undergo LP for suspected (or to rule out) meningitis, and they have a normal neurological exam (including fundi), and are not elderly or immunosuppressed, there is no need to do a CT first.
- If you’re seriously worried about meningitis and are intent on getting a CT prior to LP, don’t let the imaging delay antimicrobial therapy.
PEP consists of the following steps:
- All bite wounds and scratches should be attended to as soon as possible after the exposure; thorough washing and flushing of the wound for approximately 15 minutes, with soap or detergent and copious
amounts of water, is required. Where available, an iodine-containing, or similarly viricidal, topical
preparation should be applied to the wound.
- RIG should be administered for severe category III exposures. Wounds that require suturing should be
sutured loosely and only after RIG infiltration into the wound.
- A series of rabies vaccine injections should be administered promptly after an exposure.