The LP

Today, I had a Physician Assistant Student (PAS) in the ED. I like to teach, and I do it infrequently enough that it’s fun. Today’s topic: the Lumbar Puncture.

The PAS hadn’t seen an LP before, so we talked about it before the procedure, after a nice long talk with the patient about risks, benefits and alternatives.

This was the best, easiest, smoothest LP I have done in about 2 years, of course. The only other option, given the audience, was abject failure and humilitation, which was thankfully avoided. The patient had very little discomfort (see below), and tolerated it exceptionally well.

Afterward, everyone who had been in the room (the ED tech, the scribe, the PAS and I) were actually laughing (very very professionally) at how easily it went, and how completely unrepresentative of a usual experience the whole thing was. It was a completely unrepresentative introduction to the procedure, and everyone involved pointed that out.

If I were to make a movie about ‘how to perform an LP’ this is the one I wish I had on tape.
(Discomfort is a doctor term for pain that other people feel).


  1. Being trained for a new job once, I was told that when I asked the patient about their pain level, I was supposed to say, “So, Mrs. Sternotomy, are you having any discomfort?” Because asking if she had “pain” would be just like suggesting that any discomfort she was feeling might actually be pain and therefore be negative in some way.
    (The fact that she’d had her sternum sawed open notwithstanding.)

    Congrats on the fabulous LP, btw.

  2. Do you mean to say, that when I finish residency, not ONLY will I be able to perform smooth LPs with a single stick, leap over PAs with a single bound, and send patients thru the ED faster than a speeding gurney…but I also get a scribe???



  3. flightdoc says:

    So… you scooped the PAS out of an LP. Gunners die hard.