13th August 2024

You are the medical registrar on call. You get a call from a local GP asking for advice about a patient

You are the medical registrar on call. You get a call from a local GP asking for advice about a patient they are currently assessing. A 35-year-old gentleman has presented with a 3 day history of headache, vomiting, reduced appetite and fevers. The GP reports his observations are as follows: HR 111 bpm, BP 88/52 mmHg, temperature 38.4 degrees celsius, RR 23/minute, sats 97%. On examination, he looks unwell and has cool peripheries and a capillary refill time of 5 seconds. There is evidence of  purple petechiae on his arms and trunk which are non-blanching.  There is no focal neurology but there is evidence of photophobia. He is also complaining of pain on neck flexion. He is a civil servant and has a past medical history of migraines, however he reports that this headache feels different to the symptoms he normally gets and his triptan medication has not helped his symptoms.

What would you advise the GP to do next?

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