(particularly when combined with fever, nausea, or photophobia), altered mental status, weakness, and seizures.īacterial meningitis is classically taught as the triad of fever, neck stiffness, and altered mental status, but this triad is present in less than half of patients with the disease. Chief complaints when lumbar puncture should be considered include severe headache We will touch on the most common ED indications for lumbar puncture. The presentation of disease states that require Emergency Department lumbar puncture vary widely.
Antibiotic selection should be narrowed when culture data is available. Some facilities may recommend starting empiric steroids,īut this topic is controversial and may not be typical practice everywhere. A should be empirically started on ceftriaxone, vancomycin, ampicillin. Antibiotic resistance and sensitivities vary from hospital to hospital. Prompt antibiotic administration within 2 hours of arrival decreases in-hospital Antibiotics should not be delayed prior to obtaining the lumbar puncture. EmpiricĪntibiotics should be started promptly if providers have high suspicion for meningitis. Initial work-up would include include basic labs (CBC, BMP, LFTs), lactate, blood cultures, urinalysis, urine drug screen, ethanol levels, VBG, ECG, chest-x ray, CT- Head and Neck (additional imaging may be done based off initial work-up). Initial Actions - Thinking back to the case, what work-up and treatment would you do for Mrs. Gather additional historyįrom EMS, such as how was the patient found and what did the scene look like? How warm was the room? In order to obtain further history, call family or caregivers. Are there any rashes, transdermal drug patches, or medical bracelets on the patient? Check a core temperature and a blood sugar. A rectal tone should be assessed if the patient is unresponsive. Look for any signs of trauma, bruising or lacerations on the body. Altered patients must be undressed completely and the provider should perform an examination from head to toe. Patients presenting in status epilepticus may require heavy sedation to stop seizing, which should also prompt Patients with a GCS score of less than 8 will require an advanced airway. There should be a particular focus on obtaining accurate GlasgowĬoma Scale (GCS) and performing a thorough neurologic exam. In patients who present with significant altered mental status, it is important to quickly perform a primary survey to assess the patient’s airway, breathing, and circulation. As with any procedure, good preparation is key to a successful outcome. CSF samples should be sent for cell count, gram stain, culture, glucose, protein, and in some cases specific viral and antibody serologies or flow cytometry to help guide clinical decision-making.īefore performing a lumbar puncture, providers must be well versed in different approaches to the procedure and be aware of potential complications. Patients and will help guide clinicians in diagnosis. Initial opening pressures should be performed on all Lumbar puncture is also used as a therapeutic and diagnostic tool in patients with idiopathic intracranial hypertension (IIH, or pseudotumor cerebri). However, this topic has become controversialĪnd will be discussed in more detail below. Lumbar puncture also has historically been used in the diagnosis of subarachnoid hemorrhage (SAH) as the next diagnostic step in patients whose initial CT head is negative. Lumbar puncture is a common emergency department procedure that is used for both diagnostic and therapeutic purposes. As a diagnostic tool, lumbar puncture is used to detect CNS infections, CNS malignancies, and inflammatory processes, such as Multiple Recognize special considerations in select patient populations.Describe the lumbar puncture procedure technique.Explain the risks and benefits of lumbar puncture as discussed when obtaining informed consent.Recognize the common presentations of illnesses requiring lumbar puncture.List the indications for lumbar puncture.SAEMF/CDEM Innovations in Undergraduate Emergency Medicine Education GrantĬareer Development and Mentorship CommitteeĬommunications and Social Media CommitteeĬDEM Medical Education Fellow Travel Scholarship Presidential Address: Where Do We Go From Here?ĮMF/SAEMF Medical Student Research Training Grant Virtual Rotation and Educational ResourcesĬommittee Update: NBME EM Advanced Clinical Examination Task Force Visit us on Twitter LinkedIn Facebook YouTubeĮffective Consultation in Emergency Medicine Video
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