23rd May 2024

An 18-year-old man presents with a 1-day history of fever, rash and lethargy. You are asked to see him in ED resus

An 18-year-old man presents with a 1-day history of fever, rash and lethargy. You are asked to see him in ED resus as he is combative. He is maintaining his own airway, with an RR of 20 and saturations of 95% on air. HR is 133 bpm, blood pressure is 138/55 mmHg, temperature is 38.8 degrees Celsius. He opens his eyes to painful stimuli, is making incomprehensible sounds and localises to pain. On your arrival, 4 emergency department staff are attempting to hold him down to gain IV access, which he is not compliant with.

Which presenting feature necessitates CT head prior to a lumbar puncture, given your clinical suspicion of meningitis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.