Drowsiness or impaired consciousness | Falling conscious level, Glasgow coma scale of <13 |
Signs of septicaemic shock | Poor perfusion, low BP, tachycardia |
Clinical diagnosis of invasive meningococcal disease | Rapid onset illness, typical haemorrhagic rash |
Signs of raised intracranial pressure | Papilloedema, coma, abnormal posturing, abnormal pupillary responses, high BP, low pulse |
Focal neurological signs | On clinical examination of cranial and peripheral nerves |
Bleeding tendency | Thrombocytopenic rash or excessive bruising—check platelets and clotting screen |
| Known haemophiliac—consult haematologist |