Are there differences in the types of needles used for lumbar punctures?

The lumbar puncture kits I have used usually have quincke spinal needles. I didn’t think much of it but I noticed that some anesthesia colleagues don’t use quincke needles when they do spinals, which are essentially the same procedure. Why is this? And why aren’t they used in lumbar puncture kits?

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Why is thiosulfate mixed in with nitroprusside in some formularies?

At our institution’s pharmacy, thiosulfate is mixed in with nitroprusside infusions. However, I know that this isn’t done by all institutions. Why is this done and how is dosing of the thiosulfate determined?
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Up to what INR can a peripheral joint injection be done safely?

My clinic frequently sees many patients who could benefit from peripheral joint injections. Unfortunately, many of them are on coumadin and are somewhat high risk for stopping anti-coagulation.
In these higher risk patients I want to know under what circumstances can I safely perform joint injections while remaining on coumadin?
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Is adderall associated with coronary artery disease of any kind?

We have a 31 year old patient with a history of hypertension, tobacco use and ADHD on adderall who presented with ST elevations in leads II, III, aVF, V5, V6 and an elevated CK, CKMB and Troponin T. Catheterization indicted distal occlusions of the apical portion of the posterior descending artery and posterior left ventricular branch and an ejection fraction of 60%. The cardiologist performing the catheterization felt that there was likely thrombus in the right coronary artery causing showering thrombi which caused the occlusions above. He denied cocaine use and his toxicology screen was negative. No family history of early CAD. His HDL/LDL were 47/108. His A1c was 5.3%. Although he is a smoker and has hypertension he is only 31. His only medication is adderall for ADHD. Is adderall associated with any coronary events like that described above?


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Is it okay to do a lumbar epidural steroid injection in a patient with a schwannoma or neurofibroma?

I have a 51 year old female with chronic low back pain with radicular pain down the left lower extremity. Her MRI within the last few months shows some non-specific degenerative changes except for a T2 signal in the right lateral recess of L3-L4 which is likely a schwannoma or neurofibroma. Interestingly, note the pain is mostly left but the lesion is on the right. Her pain appears to be coming from other degenerative changes.

The lesion has been stable for years and she elected a while ago to not undergo surgery. To treat the left sided pain I was thinking of an epidural steroid injection (possibly via the transforaminal approach on the left). But I’m not sure if the lesion is a contraindication?
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