Welcome to our weekly Wednesday Wrap Up from conference today.
Dr. Rebecca Carter
- Acute monoarthritis is septic until proven otherwise
- The most common pathogen is? Staph aureus, but consider others in unusual presentations (IVDU, immunosuppression, underlying joint disease or prosthetic joints)
- Imaging and labs aren’t very helpful in diagnosing septic arthritis, but are good for excluding other causes of joint pain
- Start empiric abx early based on patient profile and smear, tailor for definitive therapy
Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 7e. Ch 281. Acute Disorders of the Joints and Bursae
EM Practice: Arthritis in the ED. October 2004
Dr. Michael Griesinger
1. Pre-LP CT: the majority of patients do not require CT scan before LP, BUT guidelines recommend CT scan for?
2. Don’t delay treatment in toxic-appearing patients.
3.Empiric treatment in adults > 50 are?
4. Give dexamethasone in suspected cases of Strep pneumo (or H. flu in pediatrics) before or concurrently with first dose of abx to prevent long-term neuro sequelae.
5. There is a disease entity practically unique to NYC called rickettsialpox associated with mice infestations – treat it, like other rickettsial infections, with doxycycline.
Dr. Jacqueline Shibata
1. If you have a painful joint with limited movement, think about your clinical picture, but then, Tap It.
2. Sensitive tests: ESR >30, synovial LDH > 250, +Crystals
3. Specific tests: Positive gram stain, synovial WBC >50,000, sLactate >10
4. Tap it!
5. Why? Because septic joints have high morbidity and mortality.
6. Treatment and Dispo?
Dr. Shibata's References Recommended: Mallin et al. Hip Ultrasound, Aspiration and Injection. Emergency Ultrasound Podcast. Episode 28. 2012. Recommended: Carpenter CR, et al. Evidence-based Diagnostics: Adult Septic Arthritis. Acad Emerg Med. 2011. Aug;18(8):781-.‐96. Rios C, Zehtabchi S. Emergency Department Patient With Joint Pain: Searching for the Optimal Diagnosis Tool. Ann Emerg Med. 2008; 52:567-569. Septic Arthritis in the Lenski et al. Analysis of synovial inflammatory markers to differ infectious from gouty arthritis. Clinical Biochemistry. 2014 Jan: Vol 47. Issue 1-2: 49-55. Burton JH. Chapter 281. Acute Disorders of the Joints and Bursae. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 7e. New York, NY: McGraw-Hill; 2011. Schmerling et al. Synovial fluid tests: what should be ordered? JAMA. 1990; 264:1009- Vieira RL, Levy JA. Bedside ultrasonography to identify hip effusions in pediatric patients. Ann. Emerg. Med. 2010;55(3):284-9. Tsung JW, Blaivas M. Emergency department diagnosis of pediatric hip effusion and guided arthrocentesis using point-of-care ultrasound. J. Emerg. Med. 2008;35(4):393-9.
By Dr Andrew Grock, Dr. Carl Alsup, and Dr. Jay Khadpe
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