Modern immunizations in conjunction with better CT imaging has likely led to declining need for lumbar puncture in the emergency department to evaluate for meningitis and subarachnoid hemorrhage. This may contribute to physician discomfort with the procedure and lower likelihood of first attempt success. This study evaluated whether the addition of ultrasound guidance could increase first attempt success on infant lumbar puncture in the Emergency Department.
HINTS Testing: series of three physical exam maneuvers to differentiate peripheral and central causes of vertigo
Head Impulse test: tests vestibulo-ocular reflex
• Patient focuses on visual spot directly in front of them
• Rotate patient’s head rapidly from center to 40 degrees to the left and back again to center, repeat on the right
Whereas the dosing of sedative medications is usually unaffected, the chief concern is whether there should be changes for neuromuscular blockade – will your patient with myasthenia gravis require a higher or lower dose of your selected paralytic?
Anatomic landmarks followed by a "blind" stick is currently the standard practice for performing bedside lumbar punctures, but with increasing use and ease of ultrasound, could we one day see lumbar punctures follow in the footsteps of central line placement?
Always looking up the clinical findings of a central vs. peripheral CN VII palsy? Wondering who to treat and who not to treat? Well...this post is for you! Click to read more about the basics of a Bell's Palsy!