Pathphys argument

Okay, not an argument, really, but we're working on a group project and one member is sticking with a different answer from the rest of us. That's totally fine by us, it won't affect the grade. But I'm having trouble understanding the reasoning.

A 20-year-old college rugby player is brought in to the ER. During a match, he took a hit. He was slow to get up and his neck is stiff. The headache is much worse. His left hand is now numb and cold. His team mates say he just isn't acting like himself so they brought him in. His roommate says he overslept, was acting kind of sluggish before the game, and complained of a headache, but blamed it on over indulging at a party in the dorms the night before. While waiting for the results of the lumbar puncture, he begins seizing.

An assessment gives the following results:

temp 39.5 C

resting heart rate 110 beats per minute

respiratory rate 30 breaths per minute

X-rays - negative for skull fracture

negative for cervical vertebrae fracture

hyporeflexia

Left hand is pale and cold to the touch.

CSF analysis:

pressure 210 mm H20

color turbid

proteins 49 mg/ dl

glucose 42 mg/dl

WBC's 580/mm3

We say meningitis, probably bacterial. The WBCs alone indicate wicked infection, but add the pressure, turbidity, seizure, and behavior BEFORE the hit and we see infectious disease, rather than trauma. That's leaving out the cold, pale hand (perfusion issue due to septicemia, we suspect). I can't remember if brain trauma can affect resp rates or not, but I suspect it can, so that and heart rate aren't necessarily indications of infection vs trauma. But there's enough *other* stuff... I guess it just seems fairly clear-cut to the rest of us. I love that she's sticking to her guns, though. TBI was actually my first thought, but when I reread the question, there were more clues pointing to infection than trauma that I changed my mind.

I'm not looking for your agreement so much as more understanding of her POV. Would anyone else say TBI instead of meningitis? Why or why not?

Thanks! I'm so loving this class, I can't stand it, even though it's kicking my butt. :chuckle