Subdural Tap

SUBDURAL TAP REASON FOR VISIT DIAGNOSTIC •Subdural Empyema •Meningitis with effusions THERAPEUTIC •Trauma

•Irritability •Mental status changes •Somnolence •Full or bulging of fontanel •Third and sixth nerve palsies •Unconsciousness •Coma •Seizures •Hemiparesis •Spasticity RISK ASSESSMENT •Bleeding disorders •Overlying infected skin •Age outside the infant/toddler group •Heart diseases •Allergies to medication •Allergies to anesthesia PREPARATION OF THE PATIENT •Blood tests •Urinalysis

•Serum electrolytes •Platelet count •Prothrombin time •Activated partial thromboplastin time (aPTT) •USG skull

•CT scan •MRI •Part was prepared and draped

ANESTHESIA Local POSITION OF THE PATIENT Supine position THE PROCEDURE •The child was in the supine position and secured in an immobilizer •A shoulder roll was placed.

•A small area of hair was clipped/shaved around the intended puncture site •The skin was cleansed with povidone-iodine •___gauge, spinal needle was inserted at a 90˚angle into the

junction of the coronal sutures and the fontanelle while holding the needle perpendicular to the skin surface. •Needle was secured in place with hemostat •The needle was advanced until a pop was felt/fluid flows. •The fluid was allowed to drain spontaneously into the sterile tubes. •The needle was removed with applying pressure over the puncture

site with sterile gauze for a minimum of 10 minutes. •Dressing was done AFTER PROCEDURE •The collected fluid was sent for histopathological study

•Temp, heart rate, respiratory rate was observed

DURATION _____min POSTOPERATIVE CARE •Give pain medication as prescribed •Give antibiotics as prescribed

COMPLICATIONS •Inadvertent vessel puncture •Vascular tears •Vascular lacerations •Cerebral edema •Infection •Contusion/laceration of cerebral cortex