CNS Infection Priority Bench: Who Do You See First
Whatever the organism, central nervous system infection kills through a small number of final common pathways — rising intracranial pressure, seizures, SIADH, shock and infarction — and a falling level of consciousness outranks every other neurologic finding because it is the earliest and most sensitive sign. Order your five patients by the rules that actually decide it, then tell the infections apart by the single finding that names each one.
0700 handover — five patients, one of youYou have just taken report. Tap the patients in the order you go to them, first to last. The bench accepts only the next correct patient, and it will tell you which rule decides each pairing.
Tap the patient you go to next
Meningitis inflames the coverings; encephalitis inflames the brain itselfThat one distinction predicts the clinical difference. Meningitis gives headache, fever, neck stiffness and a patient who is irritable but whose cortex works. Encephalitis gives altered mental status as the defining feature — personality change, psychosis, aphasia, focal deficits, movement disorders and seizures. Read each patient and name what is happening.
Where every CNS infection ends up
The rules, in the order they settle arguments
1Airway and breathing before circulation, and circulation before neurologic status. Noisy respirations in an unresponsive patient is an A and B problem and it wins.
2Any change in level of consciousness outranks every other neurologic finding, because it is the earliest and most sensitive sign of rising pressure.
3Unstable before stable. Acute before chronic. Actual problems before risks.
4Last does not mean never. Discharge teaching still happens before the shift ends — it is what prevents the next admission.