Critical Matters CNS Infections
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Jun 8, 2023 In this engaging conversation, Dr. Catherine Albin, a neurointensivist at Emory University, dives into the complexities of CNS infections like meningitis and encephalitis. She highlights the need for ICU clinicians to be vigilant due to the high morbidity associated with these conditions. Albin discusses risk factors, diagnostic strategies, and effective treatment protocols, emphasizing the importance of early intervention with antibiotics and acyclovir. Additionally, she elaborates on post-ICU recovery and the nuanced decision-making around lumbar punctures and neuroimaging.
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LP Still Useful After Antibiotics
- Starting antibiotics before LP does not nullify diagnostic value because PCR panels and glucose persist.
- BioFire PCR and low CSF glucose still help diagnose bacterial meningitis after antibiotics.
Measure Opening And Closing Pressures
- Always measure opening pressure correctly and convert cmH2O to mmHg for familiar ICP thresholds.
- Check closing pressure after removal to understand how ICP responded to CSF removal.
Use Tube 1 And 4 For Counts
- Send cell counts from tube 1 and tube 4 to identify traumatic taps and true CSF WBCs.
- Use the RBC:WBC ratio (≈800:1) to correct WBC elevation from bloody taps.
