Headache, fever, and the lights hurt

A 20-year-old student arrives febrile and confused, hiding her eyes from the examination lamp.

20-year-old womanED, resus bay 2Fictitious educational patient

Previously wellUniversity residence hall

Day 0 · 22:15

Arrival

Twelve hours of worsening headache, fever, and vomiting; tonight her roommate could not wake her properly. GCS 13, photophobic, neck stiff. No rash on a full-skin check, repeated twice.

Vitals

HR122BP104/62RR22SpO297%T39.2

Examination

Neuro: GCS 13 (E3 V4 M6); no focal deficit; photophobia; nuchal rigidity.
Skin: No petechiae or purpura on serial full-skin checks.

Suspected bacterial meningitis, 22:15. What is the correct opening sequence?

Answer the question above to continue.