Lumber Puncture

Indications:
hazard meningitis or encephalitis
o See Meningitis,  febrile convulsion, fever
Suspected Sub-arachnoid haemorrh mature with a habitual CT

 

Contraindications:

You must always argue with a senior registrar or consultant before doing a lumbar puncture.

Do non do a lumbar puncture if the child is so sick that you go out give antibiotics for meningitis even if the CSF is normal on microscopy. 

The clinical findings that counsel you should give  dexamethasone and   antibiotics   immediately, and delay lumbar puncture for 1-2 long time until the child is improving are:

Coma: absent or non-purposeful response to painful stimulus - squeeze ear-lobe firmly for up to 10 seconds. A child over 3 months of age should push you away and seek a parent.
Signs of raised intracranial pressure: eg drowsy, diplopia, abnormal pupillary responses, unilateral or bilaterally symmetrical motor posturing or papilloedema (NB papilloedema is an unreliable and late mansion of raised ICP in meningitis; a bulging fontanelle in the absence of other signs of raised ICP, is non a contraindication).
cardiovascular compromise/ shock
Respiratory compromise
Focal neurological signs or seizures
new seizures (within 30 minutes or not regained normal sure level afterwards).




Coagulopathy/thrombocytopenia
Local infection (in the area where an LP would be performed)
The febrile child with purpura where meningococcal infection is suspected.
Assessment prior to LP for contraindications?
CT Scans if focal neurological signs
o CT Scans are not helpful in most children with meningitis.
o A normal CT scan does not tell you that the patient does not have raised ICP.
o Herniation may fleet even in the presence of a normal scan.
o Dont delay antibiotics whilst waiting for a CT 
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Complications:

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