Neuro - CSF and Blood Culture Flashcards
CSF: Transports _______ and clears ________
nutrients
metabolic waste
CSF chloride: NL values ?
700-750 mg/dL
**typically it correlates with serum levels **
Lumbar Puncture (Spinal Tap) Contraindications: absolute ?
never do it
Dermatitis
CSF cells : WBC NL ?
ZERO
CSF protein: also used in ?
to evaluate for some neurologic diseases
Case Study:
Pressure: 120 mm H2O Color: clear Cells: RBC=0 WBC=80 Differential >80% lymphocytes Protein: 70 mg/dL Glucose: 40 mg/dL
What do you suspect as Dx ?
Viral Meningitis
normal glucose should be close to serum ( 70-130)
lymphocytes - alway viral
if not viral then neutrophils and PMNs
Case Study
Started an IV and began fluid bolus.
Obtained a CBC, CMP, UA, UCG, Urine culture, lactate, blood cultures x 2
Given Morphine 4 mg IV and Zofran ( antiemetic) 4 mg IV
CT scan w/o contrast (stone protocol) showed right sided hydronephrosis without stone, some stranding suggesting?
Pyelonephritis
CSF decreased when ?
dehydrated
previous taps
nasal sinus fracture with dura tear (CSF leaking out of nose)
CSF protein: mild ?
viral
CSF other tests: gram stain ?
Guide empiric treatment for bacterial meningitis
Blood Cultures: test ?
Preliminary result in 24 hours
Final results usually within 48-72 hours
Start empiric therapy
Cerebral Spinal Fluid (CSF) procedure: __ tubes from one collection point ?
4
label each tubes in succession you drew then
**lots of blood in 1 tube but not as much for 4 - it is probably from the puncturee itself and not a true blood level in the CSF **
Blood Cultures: order -
Blood cultures x 2
-Collected from 2 different sites
Avoid an arm with an IV -unless contamination of an indwelling line is suspected
Draw before antibiotics are initiated
-If drawn while on abx, draw just before next dose is given.
CSF other tests: Tumor markers ?
if there is metastasis
not primary brain CA but mets
Lumbar Puncture: post-test ?
Immediately can lie pt prone with pillow under abdomen to slow CSF flow
Lie flat for 12 hours.
Use straw to drink fluids, encourage PO fluids
Repeat Neuro exam (*legs!)
Send test stat
6-18 y.o. # of cells ?
0-10
CSF glucose: increased?
High serum glucose
DKA
follows serum level of glucose and if it is lower than serum you gonna think infection
Cerebral Spinal Fluid (CSF) procedure: Insert needle between ________ lumbar vertebrae
3rd and 4th
CSF color: turbid ?
infection
CSF protein: moderate ?
bacteria
CSF LP potential complications ?
CSF leak (H/A sxs. - they need a blood patch )
Infxn
Herniation of the brain (get CT first)
Puncture of the spinal cord/aorta/vena cava
Postural h/a or paresthesias
**CT before LP if you suspect increase pressure **
LP opening pressure ?
opening pressure - how much pressure is inside the closed circuit ( spinecord)
CSF glucose: NL values ?
60-75 or 60% of BGL
Adults # of cells ?
0-5
A 22 year old female presents to the Lake Erie College clinic with complaints of headache and neck pain since yesterday evening. Pain is 10/10 now and associated with photophobia, one episode of emesis, and continued nausea.
she might have meningitis so you want to do an LP
CSF protein Nl ?
15-45 mg/dL
CSF chloride: decreased ?
Infxn
Meningitis
so , take home point here
Blood cultures
Preliminary report – Gram neg bacilli
Final report- E.coli
what is tx ?
Began Cipro 400 mg IV
Blood Cultures: pre-test ?
Aseptic technique
Discard needle on syringe and use second sterile needle before injecting into blood culture media
CSF color: red ?
traumatic tap or blood in CSF
could be traumatic, further tubes should be clearer and clearer, blood will clot with traumatic puncture
CSF glucose: decreased ?
Bacteria
Inflammation
Tumor
CSF: Lactic acid increased >35 ?
Elevated in bacterial/fungal meningitis
Associated with decreased
O2 in the brain
Not elevated in viral meningitis
increases in anaerobic metabolism cause low O2 levels
**difference between viral and bacterial **
CSF color: yellow ?
old blood or increase in protein
Neonates # of cells ?
0-30
CSF cells : WBC - Lymphocytes = ?
viral or TB meningitis, encephalitis
CSF other tests: culture ?
abs tx.
CSF other tests: cytology ?
CA cells
Lumbar Puncture: pre-test ?
Obtain consent
Baseline neuro eval (*pt’s legs!)
Consider CT
Consider Queckenstedt-Stookey test
CSF other tests: Antigen/Antibody Tests
?
Syphillis
CSF protein: NL to large to cross the ?
BBB
CSF cells ?
RBC
WBC
CSF cells : WBC - other ?
leukemia
malignancy
CSF: LDH in adults ?
Less than 40 U/L
CSF chloride: increased ?
Correlates with blood levels
Not significant
1-5 y.o. # of cells ?
0-20
CSF color: NL ?
typically CSF is completely clear - like purest water clear
CSF increased pressure causes ?
meningitis
tumors
encephalitis
bleeds
hydrocephalus
Cerebral Spinal Fluid (CSF) procedure: be sure to uses ______ technique
sterile
CSF cells : WBC - PMNs (neutrophils) = ?
bacterial meningitis/abscess
Queckenstedt-Stookey test explanation ?
Use gentle pressure or BP cuff to jugular vein. Rise in CSF pressure by 15-40 cm H2O, Fall within 10 seconds of release.
** blockage of the CSF is suspected ( BP cuff or hand to jugular vein and a rise of pressure 15 - 40 cm of water and a fall within 10 sec)
sluggish opening pressure then we want to do this **
LP procedure own notes ?
gloves on , sterile drape and fenestrated drop
importent to feel landmarks before you put drape on
between 3rd and 4th because of spacing ( to from tops of hips and then go straight back )
obesity and no land marks you can do a US guided LP
first thing is numbing medicine and you go deeper and numb it as you go deeper and deeper ( same with epidural)
( going in with need you will feel resistance and then a pop)
pull stylet back and then see if there is fluid ( if not fluid then try again go back in)
CSF: LDH in neonates ?
Less than 70 U/L
CSF protein: what makes BBB more permeable ?
infection
inflammation
- *so protein then can cross
- *
Blood Cultures indication ?
Concern for sepsis
Post-op temp > 101.5 F
CSF NL pressure ?
75-200 mm H2O (<20 cm H2O)
Lumbar Puncture (Spinal Tap) indications ?
Meningitis
SAH
ICH
Malignancy
CSF: _______ ml bathes the brain and spinal cord and offers protection
150-200
CSF other testing ?
immunoglobulins
lyme
HIV ( meningeal type sxs. that occurs with HIV - cytomegalovirus (CMV))
Cerebral Spinal Fluid (CSF) procedure: patient position ?
Lie on side with back arched ( knees closed to chest)
CSF: Lactic Acid Nl values ?
10-25 mg/dL
CSF Lactic Dehyrogenase (LDH) increased ?
Infection
Inflammation
CNS leukemia
tissue damage in the brain
23 yo female presents with chills, nausea, right flank pain radiating to her suprapubic area x 2 days. Worsening.
Exam findings:
+right CVA tenderness
+suprapubic tenderness
Tachy HR
VS: BP 96/52 T 103.7 F R 20 SPO2 98% RA HR 118
she is febrile
think pyelonephritis - so get blood cultures for concern of sepsis
Lumbar Puncture (Spinal Tap) Contraindications: relative ?
Increased ICP (causes brain herniation)
Decreased clotting ability
