Do a Lumbar puncture and an Electro-encephalogram

You find the required equipment and explain your plan to the mother. She is frightened by the prospect of the lumbar puncture but understands the need to identify what the cause of his sleepiness. She calls her boyfriend to explain what has happened.

The EEG is arranged for the following day.

Meanwhile you asked to review two other patients in the ED. The first is a two year old girl with diarrhea and features of dehydration. You start some nasogastric rehydration and also plan to review her later. The second is a six week old with breathing difficulties and coryza. You arrange a chest radiograph and send some blood tests.

After assessing these children you review Rory again. He is still very sleepy and barely responsive to pain. His respiratory rate is 20/min, temperature 36.5C and HR 110/min, but otherwise his examination is unchanged.

During the lumbar puncture Rory stops breathing and his oxygen saturations drop. You remove the lumbar puncture needle and call the arrest team.

The team successfully resuscitate him after intubation and ventilation. He is transferred to paediatric intensive care. Before he goes he is given some broad speectrum antibiotics taken to the CT scanner.

The intensive care team ask what else will be needed in the way of investigations