EM Cases · Lumbar puncture
Suspected bacterial meningitis — LP after antibiotics, CT decision
ACEM Fellowship resus/procedure station on meningitis LP timing, CT-before-LP red flags, atraumatic needle, and CSF interpretation priorities.
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Study tools
Target exams
ACEMFRCEMABEMFRCPCCCFPEMEBEEM
Prompt
A febrile confused adult with meningism; you must start antibiotics, decide on CT-before-LP, and plan the LP/CSF pathway.
Station brief
Format. Clinical-management (resus) station, 11 minutes. You are the EM consultant.
Candidate instructions. Manage the patient aloud. State antibiotic timing relative to LP, CT decision reasoning, and how you will perform and interpret the LP.[2]
References7ShowHide
- [2]Brouwer MC, Tunkel AR, van de Beek D. Dilemmas in the diagnosis of acute community-acquired bacterial meningitis. Lancet, 2012.PMID 23141617
- [7]Arevalo-Rodriguez I, Muñoz L, Godoy-Casasbuenas N, et al. Needle gauge and tip designs for preventing post-dural puncture headache (PDPH) Cochrane Database Syst Rev, 2017.PMID 28388808
- [8]Rochwerg B, Almenawer SA, Siemieniuk RAC, et al. Atraumatic (pencil-point) versus conventional needles for lumbar puncture: a clinical practice guideline BMJ, 2018.PMID 29789372
- [9]Gottlieb M, Holladay D, Peksa GD. Ultrasound-assisted Lumbar Punctures: A Systematic Review and Meta-Analysis Acad Emerg Med, 2019.PMID 30129102
- [10]April MD, Long B, Koyfman A Emergency Medicine Myths: Computed Tomography of the Head Prior to Lumbar Puncture in Adults with Suspected Bacterial Meningitis. The Journal of emergency medicine, 2017.PMID 28666562
- [11]Chaudhuri A, Martinez-Martin P, Kennedy PG, et al. EFNS guideline on the management of community-acquired bacterial meningitis: report of an EFNS Task Force on acute bacterial meningitis in older children and adults. European journal of neurology, 2008.PMID 18582342
- [17]Young N, Thomas M Meningitis in adults: diagnosis and management. Internal medicine journal, 2018.PMID 30387309