Most shunts are tapped by neurosurgeons. Indications for an emergency physician to tap a shunt include presentations consistent with severely increased ICP and impending herniation, or acute deteriorations in mental status when neurosurgery is not immediately available. Tapping the shunt in these scenarios could be life-saving. In addition, the procedure can be diagnostic, depending upon the flow of CSF and the results of CSF laboratory studies.1
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