Neurologic

  • Burr Hole
  • Lumbar Puncture
  • Ventricular Shunt Aspiration

Burr Hole

  • Background
    • Also known as “trepanning”. Involves drilling or scraping a hole into the skull to provide drainage for expanding intracranial hematoma
  • Indications
    • Epidural or subdural hematoma w/ midline shift on imaging.
  • Contraindications
    • Lack of imaging, reasonable access to neurosurgery, GCS > 8
  • Complications
    • Damage to brain parenchyma, infection, bleeding.
Video Credit: EM:RAP

*Deep Dive: Crackin’ the Cranium: A Review of Cranial Burr Hole Decompression (emDocs)



Lumbar Puncture

  • Background
    • Insertion of a needle into the lumbar subarachnoid space for the purposes of measuring CSF pressure, administering therapeutic agents, or collecting CSF for laboratory testing
  • Indications
    • Suspected subarachnoid hemorrhage, meningitis, or GBS. May also provide relief for pseudotumor cerebri.
  • Contraindications
    • Trauma or overlying skin infection at insertion site. Suspected spinal epidural abscess. 
  • Complications
    • Post-lumbar puncture headache, spinal epidural hematoma
Video Credit: EM:RAP

*Deep Dive: Lumbar Puncture (Taming The SRU)



Ventricular Shunt Aspiration

  • Background
    • Aspirating fluid from a ventriculoperitoneal (VP) shunt may be diagnostic (evaluate for infection or blockage), as well as therapeutic (alleviates symptoms of blocked shunt). 
  • Indications
    • Suspected VP shunt infection, meningitis, or blockage
  • Contraindications
    • Infection over entry site. Relative contraindications include coagulopathy, lack of shunt imaging/information.
  • Complications
    • Infection (low risk), bleeding, CSF leak, ventricular collapse, or misplaced tap.
Video Credit: Larry Mellick

*Deep Dive: Tapping a VP Shunt (Pediatric EM Morsels)


Brandon Simpson, PA-S2
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