Ahhh, the lumbar puncture… This seemingly simple procedure seems to be the Achilles's heel or many resus docs! If you have a good baseline knowledge of how to do the lumbar puncture correctly, it is super easy. If you have bad habits, then you will make your poor patient look like a pin cushion.
In this episode, I review my 20 years worth of tips and tricks to excel at the Lumbar Puncture (LP) as well as how to avoid the most common pitfalls I see all the time.
Make a Checklist with this stuff and equipment
- Is the INR <1.6
- Is the PLT > 50,000 (some would say 100,000 but a bunch of papers in the literature saying it is safe even down to 10,000 in peds)
- PTT if they have been on heparin
- The patient is not on Plavix or NOACs
When to Get a CT Scan [NEJM. 2001;345(24):1727-33]
CT Findings with which LP Contraindicated
- Lateral shift of midline structures
- Loss of suprachiasmatic and basilar cisterns
- Obliteration of the fourth ventricle, or obliteration of the superior cerebellar and quadrigeminal plate cisterns with sparing of the ambient cistern
- I would add hydrocepahlus or mass
(Arch Intern Med 159:2681 December 13/27, 1999)
You Need an EMCrit Membership to see this content. Login here if you already have one.
- EMCrit 337 – Procedural Deep Dive – Lumbar Puncture (LP) - November 18, 2022
- EMCrit – RACC Lit Review Oct/Nov 2022 - November 10, 2022
- EMCrit Wee – Resus SCRAM Kit Dump Bag, Crash RX Drug Bag, and the Equipment I prefer for Resuscitative Intubation - November 2, 2022