Comments on: Lumbar puncture on the morbidly obese http://www.kevinmd.com/blog/2007/07/lumbar-puncture-on-morbidly-obese.html Tue, 14 Feb 2012 22:04:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2007/07/lumbar-puncture-on-morbidly-obese.html#comment-77901 Anonymous Thu, 19 Jul 2007 18:39:00 +0000 http://clients.emmense.com/kevinmd/2007/07/lumbar-puncture-on-the-morbidly-obese.html#comment-77901 The decision may be whether it's more important to get an opening pressure, or a CSF sample to rule-out infection. The decision may be whether it’s more important to get an opening pressure, or a CSF sample to rule-out infection.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/07/lumbar-puncture-on-morbidly-obese.html#comment-77900 Anonymous Thu, 19 Jul 2007 18:20:00 +0000 http://clients.emmense.com/kevinmd/2007/07/lumbar-puncture-on-the-morbidly-obese.html#comment-77900 Do you really need to give Dilaudid for a lumbar puncture?<br/><br/>I never felt a need to do that, having done a thousand-plus in hospital and office settings.<br/><br/>I suppose there's always exceptions, guess I've just not run into that problem. And of course, I've had tough spinals and huge patients in those numbers.<br/><br/>I also would have a concern about mental status. Wasn't this particular LP to rule-out meningitis? Now you've got opiates on board.<br/><br/>But hey, I wasn't there, don't know what particulars the doc faced.<br/><br/>One problem is the spinal kits usually have these dinky little 2-cc vials of local anesthetic. People get the idea that's all you can use on the patient. Now they fail at one level, want to try another level, or get landmarks wrong, or want to try a paramedian approach, etc.<br/><br/>Instead of the Dilaudid, I would advise to get more local anesthetic instead. Drop it into the tray, same as a surgeon can get local anesthetic dropped onto the tray to infiltrate a surgical incision.<br/><br/>IMHO....... Do you really need to give Dilaudid for a lumbar puncture?

I never felt a need to do that, having done a thousand-plus in hospital and office settings.

I suppose there’s always exceptions, guess I’ve just not run into that problem. And of course, I’ve had tough spinals and huge patients in those numbers.

I also would have a concern about mental status. Wasn’t this particular LP to rule-out meningitis? Now you’ve got opiates on board.

But hey, I wasn’t there, don’t know what particulars the doc faced.

One problem is the spinal kits usually have these dinky little 2-cc vials of local anesthetic. People get the idea that’s all you can use on the patient. Now they fail at one level, want to try another level, or get landmarks wrong, or want to try a paramedian approach, etc.

Instead of the Dilaudid, I would advise to get more local anesthetic instead. Drop it into the tray, same as a surgeon can get local anesthetic dropped onto the tray to infiltrate a surgical incision.

IMHO…….

]]> By: Mikehttp://www.kevinmd.com/blog/2007/07/lumbar-puncture-on-morbidly-obese.html#comment-77827 Mike Wed, 18 Jul 2007 02:19:00 +0000 http://clients.emmense.com/kevinmd/2007/07/lumbar-puncture-on-the-morbidly-obese.html#comment-77827 You cant get an OP with a patient sitting up. You cant get an OP with a patient sitting up.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/07/lumbar-puncture-on-morbidly-obese.html#comment-77806 Anonymous Tue, 17 Jul 2007 19:54:00 +0000 http://clients.emmense.com/kevinmd/2007/07/lumbar-puncture-on-the-morbidly-obese.html#comment-77806 Would have sat patient up myself...however, according to the post, the patient was given dilaudid [though she was awake enough to share in the "joy" of the tap] Would have sat patient up myself…however, according to the post, the patient was given dilaudid [though she was awake enough to share in the "joy" of the tap]

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/07/lumbar-puncture-on-morbidly-obese.html#comment-77762 Anonymous Tue, 17 Jul 2007 00:46:00 +0000 http://clients.emmense.com/kevinmd/2007/07/lumbar-puncture-on-the-morbidly-obese.html#comment-77762 Yeah, I bet you'll lose landmarks when you take someone that fat, and lay the person lateral.<br/><br/>Sit the patient up, for Pity's sake. Yeah, I bet you’ll lose landmarks when you take someone that fat, and lay the person lateral.

Sit the patient up, for Pity’s sake.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/07/lumbar-puncture-on-morbidly-obese.html#comment-77755 Anonymous Mon, 16 Jul 2007 23:31:00 +0000 http://clients.emmense.com/kevinmd/2007/07/lumbar-puncture-on-the-morbidly-obese.html#comment-77755 Now add CSF manometry to that. Now add CSF manometry to that.

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