what conditions could you diagnose with a lumbar puncture?
viral, bacterial, fungal meningitis, encephalitis, metabolic processes, inflammatory
processes (MS, GBS), variety of oncologic procedures
To administer anesthesia after a lumbar puncture, what two drugs could be used?
narcotics...
To administer anesthesia after a lumbar puncture, what two drugs could be used?
narcotics, bupivocaine
if a patient has ventriculitis or meningitis, what could be a therapeutic indication for a lumbar
puncture?
antibiotic administration of vancomycin, gentamycin
if a patient has leukemia or lymphoma, what would a therapeutic indication for lumbar
puncture be?
administration of methotrexate or chemotherapy
what type of patients should avoid lumbar punctures?
patients who are cardirespiratory compromised, patients with cerebral
herniation/increased ICP and focal neurologic signs, coagulopathy increases risk of
hematoma
what size needle should be used for a lumbar puncture and why?
22-gauge, 3.5in (8.9cm) because smaller hole decreases risk of CSF leakage
what position should patient assume for lumbar puncture?
lateral recumbent is preferred but sitting is also acceptable
why is the lateral recumbent position preferred?
to reduce risk of post-puncture headache and to obtain an accurate opening pressure
once patient is in correct position, what should you instruct the patient to do?
to adopt the fetal position or arch back like a cat to widen the gap between spinous
processes
where should a needle be inserted for lumbar puncture?
between L3--L4, or L4-L5 because these points are below termination of spinal cord
when inserting a CVL, which site has the least risk of complications?
subclavian vein or IJ?
what are the contraindications for A line placement?
infection of placement site, traumatic injury proximal to insertion site, known areas of
deficient collateral circulation (raynauds, thromboangitis)
What is the proper location for a Chest Tube?
fourth to fifth intercostal space in the anterior or mid axillary line at the horizontal
level of the nipple; once this is felt, move hand laterally toward anterior axillary line
which is the area of incision, the insertion site is one intercostal space above incision site
what size chest tube would you use in the seldinger method?
14 french or smaller usually under US guidance in radiology suite or at bedside
what size chest tube would you use for an empyema?
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