- Burr Hole
- Lumbar Puncture
- Ventricular Shunt Aspiration
- Also known as “trepanning”. Involves drilling or scraping a hole into the skull to provide drainage for expanding intracranial hematoma
- Epidural or subdural hematoma w/ midline shift on imaging.
- Lack of imaging, reasonable access to neurosurgery, GCS > 8
- Damage to brain parenchyma, infection, bleeding.
- 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
- Suspected subarachnoid hemorrhage, meningitis, or GBS. May also provide relief for pseudotumor cerebri.
- Trauma or overlying skin infection at insertion site. Suspected spinal epidural abscess.
- Post-lumbar puncture headache, spinal epidural hematoma
*Deep Dive: Lumbar Puncture (Taming The SRU)
Ventricular Shunt Aspiration
- Aspirating fluid from a ventriculoperitoneal (VP) shunt may be diagnostic (evaluate for infection or blockage), as well as therapeutic (alleviates symptoms of blocked shunt).
- Suspected VP shunt infection, meningitis, or blockage
- Infection over entry site. Relative contraindications include coagulopathy, lack of shunt imaging/information.
- Infection (low risk), bleeding, CSF leak, ventricular collapse, or misplaced tap.
*Deep Dive: Tapping a VP Shunt (Pediatric EM Morsels)
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