Pre-test

Residency ED Rotation: Lumbar Puncture
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1. Lumbar puncture is indicated for all of the following patients except:
Patient with severe headache and signs of meningismus
Patient with signs of elevated intracranial pressure and focal neurologic
deficits
Patient with acute lymphocytic leukemia in need of CNS prophylactic
chemotherapy
Patient with suspected multiple sclerosis
2. A patient is properly positioned for lumbar puncture when:
the back is extended in lateral recumbent position, spine parallel to the
table
the back is arched in seated position, spine perpendicular to the table
the back is extended in seated position, spine perpendicular to the table
the back is arched in prone position, spine parallel to the table
3. During lumbar puncture, the needle is placed:
in the midline, 15 degrees cephalad, interspace between L2 and L3
in the midline, perpendicular to the spine, inferior to L1 spinous process
lateral and superior to L4 or L5 spinous process, 15 degrees cephalad
in the midline, 15 degrees cephalad, between the L4 and L5 spinous
process
4. If the lumbar puncture attempt does not yield any cerebrospinal fluid flow
and you feel you have encountered bone, you should:
withdraw needle to subcutaneous tissue and redirect
withdraw needle completely and attempt puncture at the same site
withdraw needle completely and attempt puncture at an alternate site
all of the above
5. During collection of a cerebrospinal fluid specimen you should:
aspirate the smallest volume of fluid necessary, usually 3 to 4 ml, into tube
connect the manometer to needle hub, measure pressure, aspirate specimen
measure opening pressure, drain manometer or collect needle drip into tube
connect the manometer to needle hub, drain fluid into tube as column rises
6. The most serious complication from lumbar puncture is:
leakage of cerebrospinal fluid
spinal hematoma
headache
brainstem herniation