Two Examples of Amazingly Subpar Lumbar Puncture Procedure Notes

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Lumbar Puncture LP Spinal Tap
Lumbar Puncture (also known as Spinal Tap)

Amazingly Subpar Lumbar Puncture Procedure Note #1

Procedure:
This is Spinal Tap.


Date/Time:
Optional.

Indication:
Infectious Diseases said it was a good idea.

Resident:
Dr. Kyle Richter, PGY-1.

Attending:
Yes.

A time-out was completed to verify the correct patient, procedure, and when the cafeteria closes.  The patient was placed in the upside-down dangling-from-a-trapeze position, while I was helped up from the fetal position.  The area was cleaned and draped in unusual fashion.  1% lidocaine was misplaced.  Twice.  An intimidatingly-large needle was placed back into the kit once I got all shaky from performance-related anxiety.  Clear cerebrospinal fluid (CSF) would have been nice to obtain as would have the opening pressure #fail.  My attending was present for this botched attempt and shook her head in disappointment.  I’m sure this will reflect poorly on my evaluation.  Patient tolerated the procedure well considering a procedure wasn’t performed.  At least there were no complications.  So there’s that.

Amazingly Subpar Lumbar Puncture Procedure Note #2

Procedure:
Driving a giant sharp thing into someone’s back voluntarily.

Date/Time:
Respectfully decline.

Indication:
Need RVUs.

Resident:
Dr. Becky Anderson.

Attending:
He’s too embarrassed by me and won’t let me write his name.

Patient was placed in time-out so he could think long and hard about what he did.  We then subjected him to a spinal tap for good measure.  He was placed in the left lateral decubitus position, then the right lateral decubitus position, but then we went back to the left again.  His pubic region was shaved and cleaned for reasons still unclear to me.  1% lidocaine was used to anesthetize the patient from head to toe, but ran out around L3 to L5.  With a running start, the spinal needle was inserted, advanced into the L4 vertebral body, and bone marrow was aspirated.  Whoops.  We pulled back, got clear CSF, and that was awesome.  AWESOME.  I mean, we almost high-fived over this feat.  It was pretty badass.  After kissing the area all better like Mom would, a Hello Kitty Band-Aid was placed over the puncture site, at which point I realized I forgot to collect the CSF.  Darn.  Patient tolerated my stupidity.  My attending is muttering something about me under his breath.  I don’t think he’s happy.  Yeah, he’s not happy.  But I think he’s the type of guy that’s never happy, you know?  A curmudgeon.  Shoot, he heard me call him a curmudgeon.  FML.

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