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Annals of Emergency Medicine - VP Shunts

Paul Jhun, MD FAAEM and Clare Roepke, MD
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15:24
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Nurses Edition Commentary

Mizuho Spangler, DO, Lisa Chavez, RN, and Kathy Garvin, RN
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01:29

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EM:RAP 2016 March Written Summary 858 KB - PDF

A VP shunt patient presents with a new mass on their neck. What’s your next step?

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Todd H. -

good afternoon

nice review...

wanted to give you a fascinating case regarding VP shunt problems...
5 years ago, one of my partners saw a 7 month old with previous hx of VP shunt. Pt presented lethargic, bradycardia HR 70 but grossly non focal...bulging anterior fontanelle.. We are a community hospital, neurosurgeon that placed shunt was at University Hospital. Our neurosurgeon was in the OR, my partner suspected elevated ICP from shunt malfunction. He contacted neurosurgeon at University tertiary care hospital. Shunt tap was advised. My partner tried unsuccessfully, implying proximal problem. Pt deteriorating... They got really clever... with neurosurgery talking my partner thru procedure..my partner set up angiocath attached to syringe and 3 way stopcock..and they tapped the "anterior fontanelle".. my partner removed some fluid...patient improved mental status and increased HR..Patient was transferred to tertiary care hospital..with my partner "riding shotgun" in ambulance, withdrawing CSF with syringe every time patient deteriorated.... They went right from ambulance to OR for shunt revision... What heroic work..a life saved...!!!

Paul J. -

Holy smokes what a crazy case! On the note of anterior fontanelle tap, we're planning on showing a video of this procedure at Essentials this May. The things we have to do in EM...

Todd H. -

good morning...

Has anyone else in EmRap land ever done this??? It's like the most heroic thing I have ever heard of in 30 years!!!!

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Spring Forward Into PE Full episode audio for MD edition 236:48 min - 330 MB - M4AEM:RAP 2016 March Aussie Edition Australian 38:52 min - 53 MB - MP3EM:RAP 2016 Mars Résumé en Francais Français 52:06 min - 72 MB - MP3EM:RAP 2016 March Canadian Edition Canadian 33:43 min - 46 MB - MP3EM:RAP 2016 March German Edition Deutsche 101:18 min - 139 MB - MP3EMRAP 2016 Marzo Resumen Español Español 87:22 min - 120 MB - MP3EM:RAP 2016 March Written Summary 858 KB - PDFEM:RAP 2016 March Board Review Answers 187 KB - PDFEM:RAP 2016 March Board Review Questions 169 KB - PDFEMRAP 2016 March MP3 Files 302 MB - ZIP

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