Meningitis & Fever With Stiff Neck
Objective: Spot the meningococcal-looking crash, use PPE, treat septic shock, and move — do not wait for a hospital LP.
Why This Is Hard
College dorm, fever, headache, a rash that does not fade. Crews linger for a full neuro exam. Surviving Sepsis and pediatric septic-shock teaching: this is time-critical infection plus shock. PPE protects the next patient — you.
- Mask/eye protection per service infection control.
- Treat septic shock: oxygen, fluids per protocol with caution, early alert.
- Photophobia and stiff neck are clues, not a requirement. Infants may only be irritable or hypotonic.
Field Rules (Education)
- Clues: fever, headache, neck pain/stiffness, photophobia, AMS, non-blanching petechiae/purpura.
- Waterhouse-Friderichsen / meningococcemia can look like septic shock with a rash. Do not wait for a stiff neck.
- You will not give hospital antibiotics unless your protocol includes them (rare; SSC 2026 prehospital antibiotics only in specific long-transport shock settings).
- Notify so the ED can isolate and treat. Exposure follow-up is occupational health, not a Facebook post.
Field Pitfalls
- No PPE because they “just have the flu.”
- A 20-minute scene for a perfect neck exam while BP falls.
- Psych hold for AMS with fever and a rash.
Practice
60-second drill
Partner: 19-year-old dorm, fever, headache, non-blanching spots, BP 82. PPE, shock, destination sentence.
Related: Sepsis.
Sources & Further Study
Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.
- NASEMSO National Model EMS Clinical Guidelines (2022) — U.S. EMS model language; protocol still wins
- Surviving Sepsis Campaign 2026 — early recognition, screening, notification; prehospital antibiotics only if protocol
- CDC meningococcal disease — rash and shock clues; PPE
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Street decisions from this lesson only. After you check, the key is highlighted. Education practice — not a certification exam.