CLINICAL APPLICATIONS LUMBAR PUNCTURE Gray’s Anatomy for Students: 108–116 Netter: 155–156, 163* Clinical Application A lumbar puncture uses a spinal needle to access the subarachnoid space between the 2nd and 4th lumbar vertebrae (L2 and L4) to withdraw cerebrospinal fluid for analysis (Fig. II-1). 42 F IGURE II-1. F IGURE II-2. Anatomic Landmarks • Below the L2 vertebra. Feel spinous processes and space between processes (Fig. II-2). • Supracristal plane crosses L4. Puncture is safe just superior or inferior to this point, which avoids the spinal cord. • Superficial to deep: Skin Subcutaneous tissue Supraspinous ligament Interspinous ligament Ligamentum flavum (provides increased resistance to needle) Dura mater Subarachnoid space–cerebrospinal fluid F IGURE II-3. *The Clinical Applications in each section are cross- referenced to the following sources: Gray’s Anatomy for Students , 2e, and Netter: Atlas of Human Anatomy , 5e. Page references from each source are provided for procedures in the Clinical Applications.
Transcript
CLINICAL APPLICATIONS
LUMBAR PUNCTURE
Gray ’ s Anatomy for Students: 108 – 116
Netter: 155 – 156, 163 *
Clinical Application
A lumbar puncture uses a spinal needle to access the subarachnoid space between the 2nd and 4th lumbar vertebrae (L2 and L4) to withdraw cerebrospinal fl uid for analysis ( Fig. II-1 ).
42
F IGURE II-1. F IGURE II-2.
Anatomic Landmarks
• Below the L2 vertebra. Feel spinous processes and space between processes ( Fig. II-2 ).
• Supracristal plane crosses L4. Puncture is safe just superior or inferior to this point, which avoids the spinal cord.
to needle) Dura mater Subarachnoid space – cerebrospinal fl uid
F IGURE II-3.
* The Clinical Applications in each section are cross-referenced to the following sources: Gray’s Anatomy for Students , 2e, and Netter: Atlas of Human Anatomy , 5e. Page references from each source are provided for procedures in the Clinical Applications.
43
F IGURE II-4. F IGURE II-5.
EXTRADURAL ANESTHESIA (CAUDAL OR SACRAL BLOCK)
Gray ’ s Anatomy for Students: 116
Netter: 155, 158
Clinical Application
Introduce anesthetic solutions into the epidural space, which will anesthetize the spinal nerves exiting the dura mater.
Sacralization is the anomalous fusion of the 5th lumbar vertebra (L5) to the 1st sacral vertebra (S1) ( Fig. II-3 ).
TRIANGLE OF AUSCULTATION
Gray ’ s Anatomy for Students: 91
Netter: 171
Clinical Application
The triangle of auscultation defi nes an area that allows better auscultation with a stethoscope (due to less overlying muscle mass), to maximize listen-ing to the lungs, 6th intercostal space, and the gas-troesophageal junction on the left and assessing potential pathology.
Anatomic Landmarks
• Medial border of scapula • Lateral border of trapezius • Superior border of latissimus dorsi Note: Area of triangle increases when arms are crossed and trunk is fl exed.
