LUMBAR PUNCTURE || SPINAL TAP|| LUMBER PUNCTURE PROCEDURE || CSF STUDY|| EPIDURAL||
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- Опубліковано 27 січ 2023
- Lumbar puncture:
INDICATIONS
LP is essential or extremely useful in the diagnosis of bacterial, fungal, mycobacterial, and viral central nervous system (CNS) infections and, in certain settings, for help in the diagnosis of subarachnoid hemorrhage (SAH), CNS malignancies, demyelinating diseases, and Guillain-Barré syndrome.
●Suspected CNS infection (with the exception of brain abscess or a parameningeal process).
●Suspected SAH in a patient with a negative CT scan [3]. The use of cerebrospinal fluid (CSF) examination in the evaluation of a patient with suspected SAH is discussed in detail separately. (See "Aneurysmal subarachnoid hemorrhage: Clinical manifestations and diagnosis", section on 'Lumbar puncture'.)
The most common use of the LP is to diagnose or exclude meningitis in patients presenting with some combination of fever, altered mental status, headache, or meningeal signs. Examination of the CSF has a high sensitivity and specificity for determining the presence of bacterial and fungal meningitis.
●Idiopathic intracranial hypertension (pseudotumor cerebri)
●Carcinomatous meningitis
●Normal pressure hydrocephalus
●CNS syphilis
●CNS lymphoma
●Autoimmune encephalitis
Conditions in which LP is rarely diagnostic but still useful include:
●Multiple sclerosis
●Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy
●Paraneoplastic syndromes
●Neurosarcoidosis
●CNS vasculitis
LP is also required as a therapeutic or diagnostic maneuver in the following situations [1,2,4,5]:
●Spinal anesthesia
●Intrathecal administration of chemotherapy
●Intrathecal administration of antibiotics
●Injection of contrast media for myelography or for cisternography
CONTRAINDICATIONS
Although there are no absolute contraindications to performing the procedure, caution should be used in patients with:
When the LP is delayed or deferred in the setting of suspected bacterial meningitis, it is important to obtain blood cultures (which reveal the pathogen in more than half of patients) and promptly institute antibiotic therapy. Urgent evaluation and treatment of increased ICP, along with the administration of antibiotics and steroids, should be instituted promptly when this is suspected. Specific treatments are discussed separately. (See "Initial therapy and prognosis of bacterial meningitis in adults", section on 'Avoidance of delay'.)
TECHNIQUE
The choice of needle type (cutting versus atraumatic) and bore size can influence the risk of a post-LP headache, but also may increase the technical difficulty of the procedure. This is discussed in detail separately. (See "Post dural puncture headache", section on 'Prevention of PDPH after dural puncture'.)
Positioning - An LP can be performed with the patient in the lateral recumbent or prone positions or sitting upright. The lateral recumbent or prone positions are preferred over the upright position because they allow more accurate measurement of the opening pressure. The prone position is generally used for LPs performed under fluoroscopic guidance. (See 'Imaging guidance' below.)
The correct level of entry of the spinal needle is most easily determined with the patient sitting upright or standing. The highest points of the iliac crests should be identified visually and confirmed by palpation; a direct line joining these is a guide to the fourth lumbar vertebral body. However, this line may intersect the spine at points ranging from L1-L2 to L4-L5 [6], and tends to point to a higher spinal level in females and in patients with obesity [7]. The lumbar spinous processes of L3, L4, and L5, and the interspaces between, can usually be directly identified by palpation. The spinal needle can be safely inserted into the subarachnoid space at the L3-4 or L4-5 interspace, since this is well below the termination of the spinal cord in most patients. Spinal cord imaging is not considered necessary prior to LP, but, if performed, images should be reviewed to confirm the position of the conus prior to LP.
An alternate approach to obtaining cerebrospinal fluid (CSF) with a paramedian needle insertion through the L5-S1 space (Taylor approach) (figure 1) has been successfully used in a patient with advanced ankylosing spondylitis [8].
Correct patient positioning is an important determinant of success in obtaining CSF. The patient is instructed to remain in the fetal position with the neck, back, and limbs held in flexion. The lower lumbar spine should be flexed with the back perfectly perpendicular to the edge of a bed or examining table. The hips and legs should be parallel to each other and perpendicular to the table. Pillows placed under the head and between the knees may improve patient comfort.#shorts #medical #neet #doctor #viral #mbbs #nurse #emergency #life #trending #raj #india #motivational #biology #scince
In just 5 minute perfect....
today I will have this lp...
Hope everything go well...
👌👌
Good job doc
😂😂🎉😢😮😅😊❤
Sir phela wala injaction main local anaesthesia tha kya .
I believe that all your patents and juniors must be happy because of your politeness. 😊
You doing amazing keept up thanks so so good for me
I faced.. 17 june 2023.. have blessed baby girl
I don't want to remember that day, means my C section delivery that. Spinal anaesthesia so scary and painful 😣😖
4:45 4:45 4:45 4:45 4:45 4:45
Yes I also
Hmmm u can say dat again
Indian main log kuch v kartai haai . injaction ki baat kar Kai directly iv needle dalta hai jhut bolkar .bina sui sai sun kiye hi jage ko tho dard tho hoga hi
Yes mene bhi liya hai per muje bilkul bhi dard nahi hua tha gud gudi ho rahi thi mere 4 bar opration hua hai 4 bar liya tha mene bhi
Nice job sir👏
Sir I like this vedio ☺🥰
What do they do with the fluid that leaks out of the spine? Besides investigate it?
Sir ye producer mere 1.5 year ke bete ko kiya tha aage koi problem to nahi hogi na jab o bada hojaye ga
Really Skillful procedure but I guess the correct approach is that patient should laying on left side having flexed hips.
You are just awesome Dr. Raj Kumar mishra
🙏🙏
Its not painful during the procedure but after the procedure u will feel the pressure around the area
Headache bhi hota h
In which country is available this csf?
Sir phela injaction kya thaa local anaesthesia kya
For what this is done ... Pls someone tell since today my sisters has been performing this
Pain has many faces , smile has only one😊
Smile
Jai eu une infiltration Epidural cela soulage apres ca revient la douleur canal lombaire etroit disques degeneratifs ❤
I wish l had a doctor like you when they performed it on me,they tried for more than 10 times different so-called doctors still they didn't manage to do it ,at the end told them l cant take the pain anymore imagine squatting like a banana for more than an hour an lastly couldnt walk for a week because my back was so sore
😢
I had done 2 days a ago and it's very painful I'm completely on bed, can't do anything 😢headache gone worse, any advice please Dr how many days will take to be normal 🙏
You are doing an amazing job to treat people ❤️🙏
U r good doctor
Mera c section hoa Tha 10 din pehlay. Opration k next day se hi muje spinal headache start hogaya Tha jo ke abi tak hai. Doc ne rest ka Bola or pain killer di lekin Mera headache nhi ja raha. Now what to do
Nice jop❤❤❤
You r doing an amazing job ....hats off to you sir lots of love and best wishes from DUBAI
😮😢🎉peujikl😂😢🎉🎉🎉🎉😮hhghy
I had one and it hurted like hell i was crying and sreamming the whole dam time
❤❤😊😊🎉🎉
Mine was done laying flat on a tilt table (with fluoro guidance) and it was a piece of cake compared to how I expected them to do it (like in the video). I would not have been able to relax enough to have it done this way.
How long did it last?
@@argentinarodriguez4170 I probably spent maybe 20 minutes in the procedure room. They gave me light sedation because I had so much anxiety about it, so it didn’t feel long at all.
@@allyyyyy20 preg pregnancy Kahan kahan ho sakte hain Kaisa pregnancy hai jo Dikhta Nahin Hai ultrasound mein
A@
@@ramuchauhan6372b 💖z
Stay blessed doctor 👨⚕️👏👏👏🙌🙌🙌
🙏🙏
@@rajmishraindiasir, I also want to get lumbar puncture done. Sir give your mobile no. Please.
Omg😱
During my time in pregnancy they didn't bent like like i was in sitting position i didnt felt that injection but the main anesthesia was like some pinch me feel😊
😊
Why bend the back of patients during inject the needle
On the authority of Imam Al-Sadiq, peace be upon him:
A wise person should be truthful so that his speech can be trusted, and thankful so that he deserves more.
Source:
The book of the balance of wisdom
You are best doctor in hole world 😜
🙏
Sir jab aap csf lata ho to pressure se nhi naka skta pta hai aap ko
😮
Sir mijne Isa shiriyed injeshan kare magar pain atha hi kuch bolona sir
Я не хочу вспоминать этот день 😭😭😭мне так было больно после операция.
😮
Seeing this I can feel the pain 🥺
Mera bhi hua last month CSF test lekin muje anesthesia nahi Diya thaa doctor ne Direct hi nikal liya tha 😢
Same here mera aaj hua, bewakoof doctor direct hi kar diya
How are you feeling now, I had done 2 days a ago and it's very painful I can't move or walk around headache is worse 😢, how many days will take me to be better ❤
Very painful 😢
Mera aaj he LP test kiya hai but bina anaesthesia ke.. aur vo b third time me hua succes.. kya kuch side effect ho sakte h kya iske.. bhot pain ho raha h kyo 3 baar needle daala ..
Yes pain hota hai
Bravo pas de masque c est comme ça que les malades meurent dans les hôpitaux 😮😢
Sir please remove the music . video is great
Ok boss.. next time i wil not insert music🙏🙏
@@rajmishraindia Yes sir, song se bhi jayada hospital ki machines aur environment acchi lagti hai
So please remove the background music 😊
😂😂😂talking if many faces, you completely right 😂
Spinel anesthesia for cecerion video please
I had this done at nine yrs old I fell asleep during it do not remember anything … checking for meningitis which i had
I felt scared seeing that. 😦😦😢😢
CSF fluid bahar aaya😊
My dream
Sir, How to Determine invetigation with csf Fluid???
Opinions
Sir after test how much time we want to take rest
24 hrs
@@rajmishraindia sir today i taken the test for food and washroom am sitting is any problem sir.for washroom 40meters walk..
🎉
🙈..it look so hurtful...😭
It's very scary n painful
No it’s not painful
I had gotten this method on my recent surgery last year and I confirm that the pain is very intestive but once the doctor finishes the pain goes away I had the collection bag near my bed and I had the chance to observe the liquid tha was getting out of my spine ( 😨😨😨😨 this was a sock in the first place but once the fluid stoped the doctor ditouched the drain system and I was reliefed
Xfwt
Ahi
I want to learn from u where do u work?
Welcome dear
@@rajmishraindia ????
ဘာျဖစ္လို႔အဲ့လိုလုပ္တာလည္ ဆရာ
ما اسم العملية ؟
Dhanyawad
Please remove background music
Боже мой 😢😢😢😢у меня тоже было 2 раза норкоз😢😢
Sir is there any side effects after this process????
No
Иголочку надо менять по алгоритму
Please in English
The csf can indicate the rabies virus?
i Respect for Doctor❤️
Tasin : guys my baby is born
😅😅😊😊😅😊😊😊😊 0:29 😊😊
Hes born in 2018
🤲😅
Para que an extraído el líquido de la señora
Ji
More pain 😢
Why anesthesian are not women
is it painful process??
No sir
Good job
ယယ 😍😌😌🤣
This is very very very painful 😖😖
Great Great Britain 😢😢😢
Apne tho pehle local diya log bina local kai jhut bolkai hi needle dalta hai dirct 😢😢
Kk😅
Pennaga pirakkave koodathu
抽脊髓液時腰超級酸痛的
O😅😊l
Hhc
Boa noite
😢😢😢
Ji
Gone through 10 times... it's very painful
I just had Done 2 days ago, proceeder itself wasn't painful but after effects 😢😢 can't move since then complete bed ridden 😢, any advice how many days to become normal 🙏
@@saimanasreen8940 bro yesterday my sister got this treatment, now she is bheaving oddly. is there any sevier side effects of this treatment. Please any one give answer. we are afraid of her behaviour please anyone respond.
Xxxx
Que lodoroza tudo que ser 😐
😱🧐👎
Lumbar not lumber
Thx dear
@@rajmishraindia still needed to correct in second line
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OBRIGADA AMI HARE SAI ANTI KEKENALAN MAI AMI PANTAI KELAPA 12 TINKAT PERSIAPAN RUMAH SAKIT SWATA DR. BIN ALKATIRI SEDANG BERJALAN CARI RUMAH SAKIT ESTUDI BANDING MELANJUTKAN ESTUDU LULUSAN DR. CUBA BISA S2 KEDOKTERAN DI INDONESIA PENBANGUNAN SEDANG BERLANJUT DR. OSTICO BELEH MAI LULUSAN PERTAMA CUBA.
Not understanding ur language
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