Dr. McKean kicked off this week with another great M&M where he taught us about the utility of stress testing to predict coronary artery disease, otomastoiditis, and much more. Dr. Brenkert joined us for an hour on pediatric musculoskeletal ultrasound and then Dr. Mudd reviewed transfusion strategies in upper GI bleeding. Dr. Ventura taught us about CSF analysis and Drs. Stettler and Whitford rounded out the day with a CPC about acid-base disturbances.Read More
Lumbar punctures are common procedures to the Emergency Medical provider. Obtaining the fluid is just part of the battle however with this procedure. With the flood of results often comes a fair bit of confusion as to how to interpret them. After reading this post, you'll be able to:
- Use cell counts, protein, and glucose to distinguish between various etiologies of meningitis and determine when to order further testing
- Understand markers of bleeding in CSF and methods of distinguishing SAH from traumatic tap
So, what constitutes a “positive” tap when evaluating for subarachnoid hemorrhage?
Traditional teaching is that a positive tap is Xanthochromia or blood in the CSF
What exactly is Xanthochromia?
The word xanthochromia is simply Greek for “yellow color.” It refers to the yellow color that CSF can take in certain situations. Some of these situations are listed below:
- Elevated CSF protein
- Hypervitaminosis A
- Rifampin Therapy
- Elevated Bilirubin
What we are especially interested in when evaluating for subarachnoid hemorrhage is bilirubin and oxyhemoglobin.Read More