Carolinas Core Concepts Core Concepts in EM; a repository for Carolinas lecture summaries.


Listwa’s “Fail proof” method of Lumbar Puncture and use of the Schiotz Tonometer

Todd Listwa, M.D.


Lumbar Puncture

  • Atraumatic needles (Gertie Marx/Whitacre) have a lower rate of post LP headache compared to Quincke needle (beveled/cutting)
  • 22 g needle has a lower rate of post LP headache than larger needles. We should always request a 22g as the kit has a 20g needle.
  • Assess the anatomy and never adjust your needle position blindly. Consider depth if hitting bone, and adjust cranially or caudally if suspecting spinous process is obstruction. When deeper, adjust to pt left or right suspecting lamina or articular facet is struck by the needle.

Lavi R, Yarnitsky D, Yernitzky D, Rowe JM, Weissman A, Segal D. Standard vs atraumatic Whitacre needle for diagnostic lumbar puncture: a randomized trial. Neurology. Oct 24 2006;67(8):1492-4

Lavi R, Rowe JM, Avivi I. Traumatic vs. atraumatic 22 G needle for therapeutic and diagnostic lumbar puncture in the hematologic patient: a prospective clinical trial. Haematologica. Jul 2007;92(7):1007-8


The Schiötz Tonometer

  • The Schiötz is a non electronic, reliable measure of intraocular pressure that you should be familiar with.
  • The weights are needed to ensure reliability and to measure higher intraocular pressures
  • You cannot use the tonometer without the conversion chart


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