For those of you not of the medical persuasion, a "lumbar puncture" (or "spinal tap") is a procedure usually done to assess a patient's cerebrospinal fluid (CSF). This is the clear/yellowish liquid that encases your brain and spinal cord. A needle is inserted into a patient's lower back, just between two vertebra of the spine, and right below where the spinal cord ends. Fluid is extracted, and then analyzed in the lab. There are a number of reasons to perform an "LP," but one common example is testing for meningitis. This is a very serious medical condition caused by inflammation of the protective coverings of your brain and spinal cord. An LP can determine whether this infection may be due to a bacterium or a virus, among other etiologies.
As you might have gathered from the description above, an LP is not an atraumatic procedure. The patient curls into a ball to open up the vertebral bodies, the area is prepped with antimicrobrial ointment, and a large needle is stuck through the skin and spinal ligaments until you hit the space with all the fluid. There are plenty of opportunities to cause bleeding along the way. The champange tap then, is when there is no blood in your sample. Usually that means there was no blood in the cerebrospinal fluid (CSF), and none encountered along the way. So it's not impossible to get a clear tap, but apparently it's not always routine. And thus when you get your first one, the doc in charge buys you a bottle o' bubbly.
So my bottle of Jaume Serra Christalino is now sitting proudly on my desk at home.
It was beginners' luck; I have to admit that. It certainly wasn't perfect technique or years of experience. I just simply got lucky, but I'll take it! And as Dr. Mitchell told me, hopefully I can earn myself another bottle during residency (if I don't tell them I already popped my first during medical school).
The Emergency Department (ED) is where we get to do most of our procedures. Here, we learn to start IVs, do lumbar punctures, and intubate, among other things. We see a ton of patients and a ton of pathology. This is where I remember seeing my first case of shingles, and my first necrotizing fasciitis. It is a very interesting place. Some of you might be wondering whatever happened to my interest in Emergency Medicine. I have to admit, it certainly was number one on my list of potential specialities going into this year (Surgery wasn't even in my top 3!). With my experiences in EMS, it seemed like a plausible next step. I guess three things happened, 1) I fell in love with Surgery; 2) I always find myself wanting to follow my patients one step further after the ED; and 3) the pace in the ED is a wee bit faster than at which I want to operate.
The best example I can use to illustrate point #2 is a recent case I saw on the A side (where the crazy-ish goes down). A 50-60 year old man was transported to the ED after having an episode that his friends described as a grand mal seizure with a substantial post-ictal period. He meandered in on his own two feet with a temperature of 105 degrees F, heart rate of 150 beats per minute (that's fast), and a normal blood pressure. All his labs were normal. No evidence of infection (CBC was within normal limits), drug toxicology screen was negative, and LP was clean. He had never had a seizure before. It was just a peculiar story.
The patient was admitted to the hospital after I left, but I desperately wanted to know what was going on with him. I ended up following this patient to his story's conclusion, which was very satisfying, but I just don't like letting these cases go. I want to be on the other side of the coin: either being the one to figure out what's wrong, or fixing it.
I don't know. Maybe that's not a good reason, but I'm often left wanting more. If that isn't a good reason, loving Surgery is. So I'll stick to that.
Pop a bottle to that notion.
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