LP > CT or CT > LP ???

[SLUsagar]

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i'm going over cases for step 3 CCS...

and again am confused as to when you for sure have to CT head before you tap...

example:
reading a case about a kid, 4 mo old, fever sluggish etc etc etc...PE shows bulging fontanelle and stiff neck....

book (blueprints for CCS) includes LP and all the CSF checks (gram stain, cells, etc), but doesn't mention CT head. Don't you have to CT head before you tap? I don't wanna kill a pt on the exam b/c i didn't and they herniated.

 

[DrQuinn]

i'm going over cases for step 3 CCS...

and again am confused as to when you for sure have to CT head before you tap...

example:
reading a case about a kid, 4 mo old, fever sluggish etc etc etc...PE shows bulging fontanelle and stiff neck....

book (blueprints for CCS) includes LP and all the CSF checks (gram stain, cells, etc), but doesn't mention CT head. Don't you have to CT head before you tap? I don't wanna kill a pt on the exam b/c i didn't and they herniated.

If the patient has a focal neurologic finding, I would CT. The test is probably trying to get you to NOT answer start antibiotics. Don't ever hold antibioitics waiting for a CT/LP.

Q

 

[bustbones26]

I believe that in the board world you image the head before tap. Now in the real world you could argue this. Or if your are Dr. House, you have to tap or the TV show would not be interesting.

 

[JudoKing01]

No, if you were Dr. House you would do an emergency craniotomy in the lobby on a hunch to determine the cause of the fever, thus finding a glioblastoma multiforme in this child. You then would completely remove the brain and dissect the tumor out under a powerful microscope in a special lab while keeping the child in a state of living dead in a freezer, head still open. You would win the ratings war.