Mastering Minor Care: Knee Arthrocentesis
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Water on the knee? Dr. De Castro walks us through knee arthrocentesis. Join us as we discuss procedural pearls, ultrasound versus landmark guided approaches, and more!
Read MoreGrand Rounds Recap 6.23.21
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It is the last Grand Rounds of the academic year and we have some heavy hitters this week! Dr. Hughes reviews cases and shares clinical pearls in this month’s morbidity and Morbidity and Mortality. Dr. Wolochatiuk tames a crashing pulmonary embolism in the SRU. Dr. Skrobut discusses the toll that EM takes on all of us. Dr. Paulsen discussess supervision, professional development, and burnout.
Read MoreMastering Minor Care: Ankle Arthrocentesis
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Far too often we are faced with the situation in which we are concerned about septic arthritis in a patient’s ankle. Although tapping the ankle can be a daunting task, Dr. Leech provides us with a guide in this month’s minor care post to make difficulty with ankle arthrocentesis a problem of the past.
Read MoreGrand Rounds Recap 8.28.19
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This week started with a great Morbidity and Mortality Conference with Dr. Ham. Drs. Li, Makinen, Mand, and Skrobut then led small group workshops on HEENT emergencies. Following this, Dr. Harty led a fascinating discussion about a patient with Carotid Blowout Syndrome and Dr. Lagasse presented some of her work on trauma care and prevention from a Global Health perspective. The week wrapped up with Dr. LaFollette discussing arthrocentesis and joint loading in the emergency department.
Read MoreGrand Rounds Recap 6.13.18
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In this week’s Grand Rounds, Dr. Polsinelli started us off with the diagnosis and management of aortoenteric fistula. We then discussed burnout and failure in our wellness curriculum in a small group setting, and heard from our colleagues in pharmacy about high-dose insulin therapy for calcium channel and beta blocker overdose. Dr. Roche led us in our Mastering Minor Care curriculum with a discussion of all things arthrocentesis, and we closed with a great combined PEM/EM simulation session and oral boards practice.
Read MoreJoint Fluid Analysis in the ED
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Not all swollen joints are the same and our dogmatic definitions of septic joints are changing with each new study, so how do we use synovial fluid to define our differential of the swollen joint? Join Dr. Harty in delving through the latest in synovial fluid studies in his asynchronous intern diagnostics post on joint fluid analysis.
Read MoreGrand Rounds Recap 10/7
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Evidence Based Medicine on Tachydysrhythmias with Drs. Ludmer and Miller
- SVT is an umbrella term that includes AVNRT, atrial fibrillation and flutter, and polymorphic multifocal atrial tachycardia (MAT)
- AVNRT (AV Node Re-entrant Tachycardia) is the correct term for what is commonly diagnosed as SVT,
- MAT usually occurs in critically ill elderly patients with respiratory failure and is a poor prognostic sign, associated with 60% in hospital mortality. Treatment is to treat the causative pathology.
- REVERT Trial: Modified valsalva vs standard valsalva performed in 10 EDs with 428 patients in England. Findings included a 17% conversion with standard methods and 43% with the modified valsalva.
What is Useful in the ED to Help Diagnose or Rule Out Septic Arthritis?
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History
There are many risk factors for septic arthritis including age >80, Diabetes, Rheumatoid Arthritis, recent joint surgery, prosthesis, cellulitis. The absence of risk factors does not make septic arthritis less likely in an acute monoarticular arthritis
Physical
Monoarticular arthritis is often characterized as a warm, painful, swollen joint with limited range of motion. No studies to date have quantified specificity data on the physical exam. Therefore, clinicians must use their own clinical gestalt when interpreting physical exam findings.
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