idiotic question

[DrAwesomo]

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But I have to ask this one. For LP, the work culture is you have to have a brain CT. People would freak out if you do LP without a CT scan. (In reality, I don't think it's necessary unless there is focal CNS deficit. How many meningitis patients also have brain tumor/mass?)

Can you please shine some lights on this since you guys do plenty of epidural/spinal in OB cases? While we are on the subject: who gets epidural and who gets spinal?

 

[pgg]

But I have to ask this one. For LP, the work culture is you have to have a brain CT. People would freak out if you do LP without a CT scan. (In reality, I don't think it's necessary unless there is focal CNS deficit. How many meningitis patients also have brain tumor/mass?)

Can you please shine some lights on this since you guys do plenty of epidural/spinal in OB cases? While we are on the subject: who gets epidural and who gets spinal?

In the anesthesia world, the decision to place an epidural vs spinal depends on factors mostly related to our desired duration and density of block. Very broadly speaking, a patient having a scheduled c-section will get a spinal (fast setup, dense block, duration sufficient for surgery that starts right after the spinal is done, titration not needed) and for laboring women an epidural (setup time not as important, don't want a dense block so she can push, titratable over time, block augmentable to a surgical density if c-section becomes necessary, catheter allows infusion to continue for many hours).

We aren't going to do either in a patient who has an indication for the diagnostic LP you're talking about.

 

[deleted547339]

In the ED, we routinely are getting head CTs prior to nearly all diagnostic LPs. My understanding is that the description of herniation after LP is based on fairly limited case series in patients with CNS infections who are, presumably, already at moderately increased risk of herniation. It's defensive medicine.

In someone who is awake, alert and has no focal findings on exam, going straight to LP is probably fine. That being said, we do it.