As a newly minted staff in the last year, I'm tough on myself when things don't go right. Ok I'm always tough on myself. Had an 18 day old tonight with a new onset seizure and I could not get the LP. That's only the 2nd baby I've missed but I hate to fail! Does it get easier to accept a miss now and again?
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Procedure failures
Started by saintsfan180
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No. It always sucks. Just take comfort in knowing we've all been there.
Just part of the job
LPs are the one procedure that I still breathe a sigh of relief every time I get fluid...
I still freaking hate LPs... four years out.
The other week after multiple failed pokes I did one last Hail Mary lateral to the midline and got fluid. In my head I screamed TOUCHDOWN!
One patient suggested a dowsing-rod might help. I admit there have been a few occasions when I seriously considered it... However, thought of the pain of attempting to code it and enter it into the EMR caused me to abandon the idea.
... and then 12 hours later the patient had an epidural hematoma and had to go to the OR.
Just kidding... 🙂
-1 year out and I also can't stand LPs.
Probably.
LP is my least favorite procedure in medicine. Either it's being done in the "intractable headache" patient who just said all the wrong buzzwords to the triage nurse that documented "worst headache of life sudden onset thunderclap" who is persistently histrionic throughout the procedure and constantly moving around and won't stay in a correct position, or it is the person I am legitimately concerned has meningitis/other badness and I can't seem to get that god damn fluid to come out and I know not being able to do it actually has serious implications for this patient - especially if it means I have to start abx now and mess up future culture results
I pretty much only LP for suspected meningitis. Patients with the sandbag triage note can get the CT/CTA combo meal while they marinate in reglan/benadryl/IVF.
Semper Brunneis Pallium
This is my practice, too. I got sick of histrionic females.
This x10. Worse yet is the unseasoned MLP that writes all this down, then sends 'em home with no re-eval note, no repeat vitals, no nothing.
Get your ultrasound with the vascular probe. Use it to identify the acoustic shadows (bone). Use the pen to make marks horizontally laterally and one mark above and below in the midline.
It ends up looking something like this:
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After that it is basically a video game. Haven't missed one LP since I started using this procedure.
It ends up looking something like this:
!
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!
After that it is basically a video game. Haven't missed one LP since I started using this procedure.
