Open meningitis first for urgent recognition and lumbar puncture decisions, then use apparent hypoxaemia and DDH to sharpen diagnostic checks.
Do not delay meningitis antibiotics for lumbar puncture logistics.
Fever with neck stiffness, headache, photophobia, vomiting or a non-blanching rash needs a time-critical meningitis workflow. Open Meningitis first because it is the broadest and most immediately actionable release: it covers typical and neonatal presentations, meningococcal disease, lumbar puncture safety, paired blood glucose, CSF interpretation and urgent antimicrobial management.
The severe hypoxaemia case is the next clinical reasoning choice. It is for the moment when a low pulse oximeter reading, arterial blood gas result and bedside appearance do not fit, especially after rasburicase or in marked hyperleukocytosis. Developmental dysplasia of the hip is the steadier outpatient item for breech risk, hip examination and age-based imaging. Graphic medicine and bereavement are more reflective, but both give concrete ways to support learners and colleagues.
Fever, neck stiffness, vomiting, headache, photophobia or non-blanching rash make this the place to begin. It keeps suspected bacterial meningitis time-critical, with urgent transfer, antibiotics, lumbar puncture contraindications, paired blood glucose and CSF interpretation held together.
Severe apparent desaturation after rasburicase is worth choosing when oxygen numbers do not match the bedside picture. It links suspected acute leukaemia, G6PD deficiency, methaemoglobinaemia, co-oximetry and hyperleukocytosis-related pseudohypoxaemia.
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Hip click, uneven crawling, leg-length concern or breech history need an age-based hip assessment rather than reassurance alone. This is the paediatric and general practice choice for Ortolani, Barlow, abduction, Galeazzi sign, ultrasound, x-ray and Pavlik harness decisions.
Graphic medicine is the reflective practice item, not an acute diagnosis review. It suits educators and trainees thinking about professional identity, loneliness, debt, vulnerability and how comics or simple sketches can support patient education and clinical reflection.
A brief memorial update can still change team behaviour. Open this when bereavement after a colleague’s death needs to be named plainly, with support routes through medical schools, residency programmes or medical associations made visible rather than assumed.
When fever, headache, neck stiffness, photophobia, vomiting or rash suggest meningitis, treat it as time-critical. Do not let a planned lumbar puncture delay antibiotics in an acutely unwell patient. Check contraindications and send paired glucose if lumbar puncture proceeds.
What symptoms should prompt a meningitis pathway before reassurance?
Fever, neck stiffness, headache, photophobia, vomiting, altered consciousness, seizures or a non-blanching rash should keep meningitis or meningococcal disease in view. Neonates may present with poor feeding, lethargy, hypotonia, hypothermia or a bulging fontanelle.
When should lumbar puncture not take priority over antibiotics?
Antibiotics should not be delayed for lumbar puncture when the patient is acutely unwell. Lumbar puncture is unsafe with raised intracranial pressure, focal neurological signs, shock or significant bleeding risk.
What should you do when SpO2 and PaO2 do not fit the patient?
Reassess the patient, check the waveform, review recent drugs and compare SpO2 with an immediately analysed arterial blood gas. Co-oximetry is needed when dysmethaemoglobinaemia is possible, and marked hyperleukocytosis can falsely lower PaO2 if analysis is delayed.
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