<p begin="00:00:07.227" end="00:00:08.945" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:08.945" end="00:00:11.605" style="s2">with a superficial exam<br />type is used to perform</p>
<p begin="00:00:11.605" end="00:00:14.437" style="s2">an ultrasound guided lumbar puncture.</p>
<p begin="00:00:14.437" end="00:00:16.616" style="s2">The patient is placed<br />in a sitting position</p>
<p begin="00:00:16.616" end="00:00:18.991" style="s2">with the spine maximally flexed.</p>
<p begin="00:00:18.991" end="00:00:22.142" style="s2">The transducer is placed<br />in a transverse direction</p>
<p begin="00:00:22.142" end="00:00:24.333" style="s2">with the orientation<br />marker directed toward</p>
<p begin="00:00:24.333" end="00:00:26.758" style="s2">the patient's left side<br />in the middle of the back</p>
<p begin="00:00:26.758" end="00:00:29.416" style="s2">at the level of the iliac crests.</p>
<p begin="00:00:29.416" end="00:00:32.008" style="s2">The spinous processes<br />will appear as distinct</p>
<p begin="00:00:32.008" end="00:00:35.181" style="s2">hyperechoic peaks with<br />acoustic shadowing below</p>
<p begin="00:00:35.181" end="00:00:37.632" style="s2">and define the midline of the spine.</p>
<p begin="00:00:37.632" end="00:00:40.818" style="s2">The transducer is slowly moved superiorly</p>
<p begin="00:00:40.818" end="00:00:43.706" style="s2">until the next spinous<br />process is identified.</p>
<p begin="00:00:43.706" end="00:00:46.199" style="s2">The transducer is rotated 90 degrees</p>
<p begin="00:00:46.199" end="00:00:48.242" style="s2">with the orientation<br />marker directed toward</p>
<p begin="00:00:48.242" end="00:00:49.707" style="s2">the patient's head.</p>
<p begin="00:00:49.707" end="00:00:52.646" style="s2">The two previously<br />identified spinous processes</p>
<p begin="00:00:52.646" end="00:00:55.552" style="s2">will now appear as<br />crescent-shaped, concave,</p>
<p begin="00:00:55.552" end="00:00:57.792" style="s2">hyperechoic structures.</p>
<p begin="00:00:57.792" end="00:01:00.857" style="s2">The gap between the bright<br />hyperechoic convexities</p>
<p begin="00:01:00.857" end="00:01:03.796" style="s2">is the inner spinous<br />space and defines the area</p>
<p begin="00:01:03.796" end="00:01:07.879" style="s2">in which the lumbar puncture<br />should be performed.</p>