End of my 3rd week of pediatrics with one more to go. My fellow intern and I have a friendly competition going on. Several of our peds patients present with symptoms suggestive of an infectious disease process involving the CSF. Being a resident in the lovely state of Pennsylvania - thick with woods and replete with ticks - allows me frequent acquaintance with the clinical manifestation of Lyme disease. This tick-borne illness is common in the summer time when kids go out camping in the great outdoors. With a fever, headache and rash, a lumbar puncture becomes indicated to rule out infections such as Lyme meningitis.
Last week, my fellow intern performed a most excellent lumbar puncture on a patient. The lab receives the 2-3 ml of (usually) clear fluid and in a few hours reports the findings: RBCs, WBCs, proteins, etc. The fewer RBCs, the more 'clean' the tap and the more accurate the CSF lab results. 'Champagne' tap means RBCs of 0. His results were excellent: RBCs, 2. After a long week of work, and at 6pm on a Friday, a patient presented to the ED with the classic symptoms, and soon I began preparing for my first pediatric LP. With some supervision and a very brave little girl, the tap was soon done and the results came in: RBCs, 0. It was a most rewarding way to end the week.
