A 76-year-old male with gout, osteoarthritis, diabetes, renal failure on dialysis, and CAD presents with right knee pain for 3 days. He is really mad that the knee pain has prevented him from walking to the coffee shop for the last two days to be grumpy with the other grumpy old dudes. He complains about everything- but he doesn’t report feeling sick, no fever, or any other illness. He says that it feels like he’s got “a touch of the gout.” Exam shows normal vital signs, grumpy guy with a red, swollen, hot, tender right knee with decreased range of motion. What ever shall we do to help this guy?Answer
You think he has gout? Really? Is his osteoarthritis acting up? No way. This is a septic joint until proven otherwise. Oh…you say he doesn’t have a fever or feel sick? There is ONLY 1 WAY to KNOW FOR SURE- arthrocentesis. You will not miss a septic joint if you aspirate fluid and send it for analysis- culture, cell count, glucose, crystals, Gram’s stain, synovial fluid lactate level (the most specific test for septic arthritis). The only absolute contraindication to arthrocentesis is overlying cellulitis, but many people are hesitant in people with bacteremia and with joint prostheses. Tap that knee, ya hear?
By: Andy Grock and Sally Bogoch. Source: Rivers…..
The following two tabs change content below.
sbogoch
Latest posts by sbogoch (see all)
- Management of the Post-Cardiac Arrest Patient - April 9, 2015
- 3/10/2015: Bored of Cardiologists, not Cardiology - March 10, 2015
- Bored review: 3/3/2015 Looking Beyond the Injury - March 3, 2015
0 Comments