A comparison of Australasian jurisdictional ambulance services’ paramedic clinical practice guidelines series: Adult sepsis

IntroductionThis article forms part of a series that seeks to identify interjurisdictional differences in the scope of paramedic practice and differences in patient treatment based upon which jurisdiction a patient is geographically located within at the time of their complaint. Methods The current CPGs of each JAS were accessed during June 2020, and updated in August 2021. Content was extracted and verified. ResultsNine services provide antibiotics for meningococcal septicaemia, with dosage ranging from 1 – 4 grams. Five services provide antibiotics for non-meningococcal sepsis (three under doctor approval), with choice of antibiotic including Ceftriaxone, Benzylpenicillin, Amoxicillin, and Gentamicin. Three services provide antipyretics, one provides corticosteroids under doctor approval, and all provide fluids (with dosage ranging from 20 – 60 ml/kg). ICPs are allowed to provide adrenaline infusions in nine services, noradrenaline in three services (one requiring doctor approval), and metaraminol in three services. Two additional services restrict metaraminol to specialist paramedics, with one of these requiring doctor approval. Two services perform phlebotomy and one takes lactate. Paramedics perform unassisted intubation in one service, with nine restricting this to ICPs. Facilitated or Ketamine-only intubation is performed by ICPs in one service. Rapid or delayed sequence induction is performed by ICPs in six services, and restricted to specialists in two services. ConclusionThe domestic jurisdictional ambulance services in Australasia have each created unique treatment clinical practice guidelines that are heterogeneous in their treatments and scopes of practice. A review of the evidence underlying each intervention is appropriate to determining best practice.

The skeletal consequences of meningococcal septicaemia

Meningococcal septicaemia and its complication of purpura fulminans has a significant impact upon the extremities as the ischaemic insult caused by the intravascular thrombosis typical of the fulminant infection can lead to gangrene and tissue loss in the acute phase of illness and the late sequelae of growth arrest and deformity. The initial management and long-term assessment and intervention are described in this chapter.

Biodegradable temporising matrix in severe meningococcal septicaemia: a case report

Expanding experience with NovoSorb Biodegradable Temporising Matrix™ (BTM, PolyNovo Biomaterials Pty Ltd, Port Melbourne, Victoria, Australia) for complex wounds encouraged its use in the following case, which required reconstruction of extensive soft-tissue defects with exposed bone resulting from the sequelae of meningococcal B infection with septic shock and disseminated intravascular coagulation.

A case report of bilateral uveitis with meningococcal septicaemia resulting to blindness and adjustment disorder

To report the rare case of a patient with bilateral uveitis with meningococcal septicaemia from Neisseria meningitides, resulting to blindness and adjustment disorder. A 9-years-old boy presented to the Emergency paediatric unit of a hospital with complaints of fever, and neck stiffness of one week duration. There was associated sudden decreased vision, pain and photophobia of both eyes. Neck was stiff and retracted with positive Kernig’s and Brudzinski’s signs. Neisseria meningitidis was isolated from both the turbid CSF and the blood. Visual Acuity (VA) was Perception of Light (PL) and Counting Finger (CF) in right and left eyes (RE and LE) respectively, with 360 degrees posterior synechiae and pupillary membrane. Diagnosis of meningococcal septicaemia with bilateral uveitis was made. Patient was treated with IV ceftriaxone, sub-conjunctival dexamethasone, dexamethasone, atropine and moxifloxacin eye drops and other supporting medications. Although he showed improvement of VA to RE-6/36, LE- 6/24, he absconded from follow- up and later relapsed with subsequent blindness (VA of Perception of Light in Both eyes) and symptoms of adjustment disorder. Although ocular involvement is rare in meningococcal septicaemia, patients should always have detailed ophthalmological examination as prompt diagnosis and management could improve the visual outcome.

The Impact of Meningococcal Septicaemia on the Developing Dentition

Meningococcal septicaemia is an acute bacterial infection with high morbidity and mortality. The infection can cause multiple systemic manifestations including disseminated intravascular coagulation, haemorrhage, infarction and necrosis of internal organs and bone abnormalities. Children with meningococcal septicaemia present most frequently between the ages of 3 months and 5 years; a crucial period for the developing dentition. Disturbances to developing dentition are frequent sequelae of this infection and include hypoplasia and hypo/hypermineralization, failed or delayed eruption, root and crown malformation. This is thought to be related to subclinical premaxillary osteomyelitis secondary to septicaemia. This case series describes three patients with rare but similar patterns of dental development, notably in the anterior maxillary region, following meningococcal septicaemia in early childhood. The patient journey through multidisciplinary assessment and management is explored, from initial diagnosis to definitive oral rehabilitation. This article underscores the importance of effective communication and care pathways between the dental team and wider medical profession. CPD/Clinical Relevance: To raise awareness of the impact of early childhood meningococcal septicaemia on the developing dentition and the potential need for referral to secondary dental care.

Purple colouration

The many disorders causing purple marks or discolouration in the skin are defined in this chapter with short summaries and clinical images for many. Differentiation is made between petechiae and purpura, and important causes are outlined. These include trauma (bruising); abnormalities of platelets and other clotting factors; vessel fragility and sepsis. Particular attention is given to meningococcal septicaemia and its diagnosis and management according to national guidelines. A short section on other infective causes is also included. There is a description of the investigation and management of cutaneous vasculitis that includes Henoch–Schönlein purpura. Special considerations for purpura in the neonate are given and the chapter ends with the diverse causes of purple patches other than purpura.