What's in a Tap: CSF Analysis

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What's in a Tap: CSF Analysis

Lumbar punctures are common procedures to the Emergency Medical provider.  Obtaining the fluid is just part of the battle however with this procedure.  With the flood of results often comes a fair bit of confusion as to how to interpret them.  After reading this post, you'll be able to:

  • Use cell counts, protein, and glucose to distinguish between various etiologies of meningitis and determine when to order further testing
  • Understand markers of bleeding in CSF and methods of distinguishing SAH from traumatic tap

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Grand Rounds Recap 12/9/15

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Grand Rounds Recap 12/9/15

Glucose Emergencies

Remember the "I's" when looking for cause of DKA/HHS: Infection, Insulin lack, Infarction (MI, CVA, Ischemic gut), Indiscretion (EtOH, cocaine), Infant (pregnancy).

After 2L NS fluid bolus in the hemodynamically stable patient, the corrected sodium should guide fluid choice for further therapy.

Venous pH, HCO3 and base excess have sufficient agreement to be interchangeable with ABG in the ED.

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Isn't that CT Enough? - Water Cooler Breakdown of CT vs CT/LP for SAH

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Isn't that CT Enough? - Water Cooler Breakdown of CT vs CT/LP for SAH

Why Should You Care?

  • Headache approximates 2% of presenting complaints to the ED, and SAH is identified in approximately 1% of those patients with headache in the ED.
  • Overall mortality of SAH is high, estimated at 25-50% of patients dying within 6 months
  • If not fatal, SAH leaves approximately 33% of survivors with some appreciable neurological deficit affecting their ADLs.
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