CT before LP?

  • 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.

Rabies vaccines and immunoglobulins: WHO position

PEP consists of the following steps:

  1. 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.
  2. 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.
  3. A series of rabies vaccine injections should be administered promptly after an exposure.