05-19-2007, 06:55 PM
A 62-year-old man is brought to the emergency department after friends found him lying face down in an alley behind a tavern. His friends last saw him 2 days ago, while he was drinking heavily. He is unable to provide any information, and his companions know nothing about his medical history.
On physical examination, temperature is 39.9 °C (103.8 °F), pulse rate is 120/min, respiration rate is 14/min, and blood pressure is 76/50 mm Hg. No rash is noted. His neck is stiff, and his shoulders can be lifted off the gurney by raising his head. Several old stab wounds are noted, and he has a long surgical scar on the left upper abdominal quadrant. Blood culture specimens are obtained, and a lumbar puncture is attempted but is unsuccessful.
Which of the following persons who came in contact with this patient should receive prophylaxis for bacterial meningitis?
( A ) The friends who were drinking with him
( B ) The rescue personnel who lifted him from the alley
( C ) The triage nurse who obtained his initial vital signs
( D ) No one requires prophylaxis
On physical examination, temperature is 39.9 °C (103.8 °F), pulse rate is 120/min, respiration rate is 14/min, and blood pressure is 76/50 mm Hg. No rash is noted. His neck is stiff, and his shoulders can be lifted off the gurney by raising his head. Several old stab wounds are noted, and he has a long surgical scar on the left upper abdominal quadrant. Blood culture specimens are obtained, and a lumbar puncture is attempted but is unsuccessful.
Which of the following persons who came in contact with this patient should receive prophylaxis for bacterial meningitis?
( A ) The friends who were drinking with him
( B ) The rescue personnel who lifted him from the alley
( C ) The triage nurse who obtained his initial vital signs
( D ) No one requires prophylaxis