Osler Medical Handbook by K Nilsson

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Post–lumbar puncture headache. [7] a. Incidence. Occurs in one in nine lumbar punctures performed with a 26-gauge spinal needle and one in three lumbar punctures performed with a 22-gauge spinal needle. [8] b. Timing. May start within minutes or up to 48 hours after completion of the lumbar puncture and may last a day to 2 weeks. c. Risk factors. Younger patients, female patients, prior lumbar puncture headache history. 5. Minor backache. Occurs in 90% of cases. 6. Implantation of epidermoid tumors.

Administer aminophylline for persistent airway resistance. 11. Administer glucagon 5-15 µg/min IV for patients on beta-blockers. IM, intramuscularly; IV, intravenously. PEARLS AND PITFALLS ▪ Skin tests for penicillin allergy may remain negative up to 6 weeks after a systemic allergic reaction to beta-lactam antibiotics. Skin testing should be repeated if clinically indicated. ▪ A history of penicillin-induced toxic epidermal necrolysis or Stevens-Johnson syndrome is an absolute contraindication to readministration, including penicillin skin testing.

Positive-pressure ventilation. C. COMPLICATIONS Chest wall hematoma or hemothorax, pneumothorax, infection, lung, hepatic or splenic laceration or puncture, reexpansion pulmonary edema, and hypotension if volume depleted. D. TECHNIQUE 1. Review chest radiograph of patient in the erect and lateral decubitus positions and confirm location of the pleural effusion. 2. Place the patient in a sitting position over the edge of the bed, leaning over a bedside table ( Fig. 2-5 ). Percuss out the effusion by noting the superior edge of dullness on the posterior aspect of the chest wall.

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