Spinal Epidural Abscess

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Spinal Epidural Abscess

Spinal epidural abscess - what was once a 'white whale’ diagnosis in the Emergency Department, has, with the opiate epidemic and rise in IV drug use, become a consistent specter in our differential diagnoses. Potentially debilitating, potentially deadly, devilishly difficult to diagnose in it’s early stages; spinal epidural abscesses have become a persistent concern for patients presenting to the ED with back pain. Much like syphillis, lupus, and HIV, the response to the question of “could it be a spinal epidural abscess?” is usually “ughh, yeah I guess so.”  In this article, we will briefly cover the pathogenesis and presentation of spinal epidural abscessed and delve more deeply into the question of how best to treat these patients?  What are the triggers for surgical intervention? Are patient’s with neurologic deficits doomed to a life of persistent neurologic disability?

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Cotton Fever

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Cotton Fever

When a patient with a history of recent IVDU presents with a complaint of fever, the mind of the provider should immediately focus on the numerous possible infectious complications that can arise.  Infectious endocarditis can lead to septic emboli spread to any organ system.  Pneumonia can result from aspiration or septic embolization. Cellulitis/abscess can obviously result from local injection.  But what about when a source of fever is not readily identifiable? When cultures are negative and the patient’s symptoms have resolved, what could have been the cause of their febrile illness?

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Grand Rounds Recap 7/27/2016

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Grand Rounds Recap 7/27/2016

This week in Grand Rounds we reviewed the morbidity and mortality cases from June and learned about infective endocarditis, intimate partner violence, tracheal injuries, pituitary adenomas, hepatic encephalopathy, epistaxis, and carfentanil - a new and dangerous adulterant in heroin. Dr. Denney was challenged to a case of dural venous sinus thrombosis. We learned about the life of an Air Force Reserve physician with Dr. Powell. Dr. Derks taught us about negative pressure pulmonary edema. Finally, we asked the question #whatsyourquestion? and reviewed how to call a good consult. Read on!

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Approach to Reading MRI of the Spine

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Approach to Reading MRI of the Spine

It's another back pain type of day in Minor Care.  3 hours into your shift and you've seen 6 patient's with back pain.  You quickly evaluate them asking them about red flag symptoms, searching for signs of neurologic injury on your physical exam.  As you talk to Jane, your next patient, you get worried she doesn't have simple musculo-ligamentous back pain.  Jane has a history of IVDU and states her last use was 3 months ago.  She cites some subjective fever and chills over the past several days along with aching low back pain which has been getting steadily worse.  On exam, you find she is febrile with a temperature of 101.4, tachycardic to 110, with a normal blood pressure.  She has midline upper lumbar and lower thoracic spinal tenderness to palpation.

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