Infection at<unk>  site
Suspected spinal epidural abscess
Trauma at the site
Tranfuse if platelets <25,000
INR >1.5
Hemophilia, von Willebrand disease, other coagulopathies
If hemophiliac, replace factor before<unk> 
If hemophiliac, replace factor before<unk> <unk>  without CT is likely safe if:
History
Age < 60
Not immunocompromised
No history of CNS disease
No seizure within 1 week of presentation
Physical Exam
No altered level of consciousness
Ability to answer two consecutive questions successfully
Ability to follow two consecutive commands successfully
Normal neurologic exam
Age < 60
Not immunocompromised
No history of CNS disease
No seizure within 1 week of presentation
No altered level of consciousness
Ability to answer two consecutive questions successfully
Ability to follow two consecutive commands successfully
Normal neurologic exam
Ability to answer two consecutive questions successfully
Ability to follow two consecutive commands successfully
If none of the above, chance of normal ct is 97%; none of the patients herniated
CT findings that prohibit<unk> :
Midline shift
Unequal pressures between the 3 cerebral compartments (left/right supretentorial compartments, posterior fossa)
Intracerebral masses not causing midline shift
Obstructive Hydrocephalus
Enlargement of ventricles prox to lesions and normal ventricles distal (especially 4th ventricle)
Basilar cisterns compressed
Lateral/3rd ventricles may be small due to diffuse cerebral edema or enlarged due to obstr. hydroceph. +/- shift
Posterior fossa mass
Displacement/compression of 4th ventricle
Unequal pressures between the 3 cerebral compartments (left/right supretentorial compartments, posterior fossa)
Intracerebral masses not causing midline shift
Enlargement of ventricles prox to lesions and normal ventricles distal (especially 4th ventricle)
Lateral/3rd ventricles may be small due to diffuse cerebral edema or enlarged due to obstr. hydroceph. +/- shift
Displacement/compression of 4th ventricle
Lumbar puncture
Ventriculoperitoneal shunt drainage
CT brain interpretation
NIH Stroke Scale
Therapeutic hypothermia
Modified Rankin Scale
Brain MRI
Awake intubation