CESI, how high

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Wasn’t ampaphb the one who advocated for series of 3 epidurals?
 
Dr. Ice said:
Wasn’t ampaphb the one who advocated for series of 3 epidurals?
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Can't answer your direct Q but I will say there have times where I wanted to do just that but didn't.

Acute HNP with red hot leg pain needs > 1 ESI in most cases. I have had pts follow up 1 week after the first ESI and gotten their second very quickly, but I sort of wish I could just do one on Monday and Friday of the same week.
 
Agree, but those who were advocating series were doing them despite improvement from one and not having adequate discussion about other methods of management. It is partly that dogmatic practice pattern that has landed all our us in our current predicament of declining reimbursement year over year and having to decipher what Cms actually wants us yo do to get paid..
 
If you guys haven’t seen this Pupalla guy’s insta page you really should. I mean he did a 5 level cervical perc disc on a patient! Wtf…you honestly have to be on a Dr. Death level to consider something like that. He apparently does a ton of cervical perc disks. I’m really curious how many complications he’s had

One particular photo of a 3 level kypho he posted looked like only one level was fractured. It’s all very concerning
 
Ferrismonk said:
Pity that lead migrated.

Edit: Wow, that's on his front page! Also goes to show that board certification doesn't mean a damn thing.
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this is right next to a picture of disgraced former HHS secretary tom price.

i know you shouldn't judge a book by its cover, but this guy just looks like a cheesedick
 
CLO @ 50 degrees with 25G Quincke tip - does this seem epidural?


ipad_phm_photo_.jpg
 
agreed, it seems posterior.

it also seems you are scattering radiation to the wind and the open space behind a persons spine. that radiation is bouncing around in that room before it dissipates.

move the c-arm down a little caudally and inferiorly to focus just on the spine at C7, collimate down to a softball size, use low dose, and you will get a better picture and a lot less radiation.
 
Posterior. When in doubt grab a lateral. It’s not much use for getting the needle in but once you’ve injected the contrast you can usually see a nice clear posterior epidural stripe even if the CLO is unclear. Agree with comments Re: collimation as well.
 
Analgesia108 said:
CLO @ 50 degrees with 25G Quincke tip - does this seem epidural?


View attachment 354475
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Posterior, that line going from anterior upper lamina to posterior lower lamina is typical spread when your just posterior and think you get a false loss. Put stylet back in to get good view of needle tip, columinate in, check AP to make sure your still under contra lateral lamina. I don’t typically do a lateral in cervical spine for ESI because the contra lateral is always a superior view. Advance another 1mm and your probably epidural.
 
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