There are a few cases I could talk about… Ultrasound guided LPs have turned out to be a surprisingly useful skill. Lucky for you, I’ve restrained myself.
The first time I heard about ultrasound guided LPs was during a spectacular yearlong ultrasound elective in medical school. I was sitting in the doctor’s pod with THE ultrasound attending of ultrasound attendings. He casually asked “Have you ever heard of ultrasound guided LPs?” Never. “Do you want to see one?” Obviously. He explained how ultrasound guided LPs follow the principle of “Measure twice. Cut once.” He spent a minute (and I mean literally just one minute) visualizing the spinal landmarks and marking them on a somewhat altered, seriously chunky patient. He proceeded to get the LP in one stick! I remember thinking he was a wizard in that moment, a wizard who uses ultrasound to elevate patient care to another level; and that I want to be the badass attending that gets LPs on obese, altered patients in one stick. I had to learn this skill…
One year and a few ultrasound guided LPs later, I found myself on an internal medicine rotation. By then I had earned myself a reputation as “the ultrasound chick”. My first senior resident was also especially interested in bedside ultrasound. On our first day without prompting he said “bedside ultrasound is the future of medicine.” I literally did a small happy dance and told him we were going to have a great month. And we did! Internal medicine had never seen so much ultrasound before our partnership. It was wonderful! Fast forward a couple months. The above senior resident catches me in the hall and asks my team if he can borrow me. “I’ve got a patient for you!” It’s an obese, ICU patient with suspected meningitis, who has failed multiple LP attempts. “Can you do an ultrasound guided LP for me?” We were at a small community hospital without interventional radiology. Fluoroscopy isn’t an option (and moving her seems like a bad plan anyway). We roll in the ultrasound, identify the spinous interspace, mark it, and start the LP. I get the CSF and we do happy dance in the hall… Another patient wins thanks to bedside ultrasound!