There's a First For Everything

Today was a huge day in my medical education.

I performed my first lumbar puncture on a newborn.

For those of you who aren't familiar, a lumbar puncture (a.k.a "spinal tap") is a procedure done in order to collect a sample of the fluid that surrounds the spinal cord.  This is known as cerebrospinal fluid and can help diagnose a multitude of conditions including infections like meningitis.  A needle is introduced in between the vertebrae and into the subarachnoid space and the fluid is sent to the lab for evaluation.  If done properly, the risk of hitting the spinal cord is actually very low because it ends a little higher than where we insert the needle.  Nevertheless, it is still not an easy or risk-free procedure. 

                                                                                     photo: http://www.cancer.umn.edu/

Usually the residents want practice and take the opportunity to perform the lumbar puncture before medical students.  Well, today was my lucky day!  The general philosophy in this pediatric emergency department is "your patient, your procedure." So when the attending physician quietly informed me that the patient coming into Room 2 was a four day old with fever, I just about jumped across the desks to click the computer and assign myself to the patient.  I knew without ever seeing him or talking to the parents that the baby would need a lumbar puncture and I wasn't going to let one of the residents claim the patient first.

You see, any baby below the age of one month who presents with fever automatically gets blood drawn, urine samples, a lumbar puncture, and an overnight hospital admission with IV antibiotics.  This isn't because they are definitely sick - in fact most of these babies just have a virus.  However, upwards of 12% have a serious bacterial illness and this is not something worth gambling against.  This unique subset of patients is susceptible to its own list of infections and the history and physical exam in babies this young is difficult to interpret.  It may seem excessive, but the risk/benefit scale tips to erring on the side of caution.

The attending told me I had one shot and if I couldn't get it, then the senior resident would take over.  I'll spare you the details for those of you who may have queasy tendencies...

The story ends with me carrying my four vials of cerebrospinal fluid out of the patient room and the attendings and residents cheering for me. 

Today was a good day.

*Don't worry, the baby was fine.*