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15 - Masque chirurgical. Ce masque est ~ faire porter au patient suspect d'avoir une m~ningite. L'objectif est de prot~ger l'entourage. Rechercher des troubles de la conscience et du comportement. Rechercher syst~matiquementun purpura : l'examen doit ~tre soigneux car le purpura peut ~tre dissimul~ par les chaussettes ou le slip du patient ! La d~couverte d'un purpura associ~ ~ un syndrome m~ning~ impose la raise en route immediate d'un traitement antibiotique : injection intramusculaire de ceftriaxone (Roc~phine | 2 g).

Rechercher des troubles de la conscience et du comportement. Rechercher syst~matiquementun purpura : l'examen doit ~tre soigneux car le purpura peut ~tre dissimul~ par les chaussettes ou le slip du patient ! La d~couverte d'un purpura associ~ ~ un syndrome m~ning~ impose la raise en route immediate d'un traitement antibiotique : injection intramusculaire de ceftriaxone (Roc~phine | 2 g). La ponction lombaire ne doit pas faire retarder le traitement : les chances de survie du patient d~pendent de ia rapidit~ ~ la raise en route du traitement.

ABORD CLINIQUE DES URGENCES AU DOMICILE DU PATIENT L'utilisation d'un d~bim~trede pointe* (fig. 8) objective un d~bit expiratoire inf&ieur ~ 30 % de la valeur th~orique. Les signes de mort imminente sont les troubles de la conscience et/ou des pauses respiratoires, voire l'arr& ventilatoire. Fig. 8 - D~bitm~tre de pointe. I1 permet de mesurer ie d~bit expiratoire maximum. L'appareil mesure environ 10 cm. Que faire devant un asthme aigu grave ? Le m~decin doit d'abord : maintenir le patient en position semi-assise ; ouvrir ceinture, bouton de pantalon, col de chemise et cravate ; - t~l@honer au SAMU* en composant ie 15.

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