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...!!!
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...
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Todd H. - March 6, 2016 1:27 PM
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. - March 6, 2016 4:35 PM
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. - March 7, 2016 6:35 AM
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!!!!