Apologies for lack of clarity - should have written "sedation best avoided
if you're going to do the LP with them sitting up and curled forwards".
There is of course no single way to do anything in medicine (as previous
shoulder reduction discussion showed)
James Cameron.
----- Original Message -----
From: "Paul Bailey" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, March 01, 2006 1:57 AM
Subject: Re: SAH and LP
> Quoting James Cameron <[log in to unmask]>:
>
>> The easiest way to access the CSF in GCS 15 patients is getting them to
>> sit
>> and curl forwards as much as possible to open up the gap. This reduces
>> 'digging around'.
>
> OK, let's not get into a 'my way of doing the procedure is better than
> your
> way' conversation. I do it with the patient lying on their side. You do
> it
> with them sitting up. You might find it easier that way. That doesn't
> mean
> that I do!
>
>> It's how anaesthetists do it on labour ward. It does mean
>> you can't measure their opening pressure, but in the patient with 'LASH'
>> you're looking for SAH not Benign Intracranial Hypertension anyway.
>
> I don't measure their opening pressure anyway.
>
>
>> Sedation not needed (and best avoided) this way.
>
> What evidence do you have that sedation is best avoided in this situation?
> Didactic statements like that are easily made and purely a matter of
> opinion.
> I believe the complete opposite and I'm happy to say that I don't have any
> evidence to support it either. Other than what I witness when I see my
> colleagues doing them without local. And the feedback that I get from my
> nursing colleagues that my way is 'kinder' to the patient. I'm not in any
> way
> attempting to get the rest of you to do things my way, I was just
> responding
> to a question from Adrian about my own personal practice.
>
> PB
>
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