Septic Arthritis is often at the top of our differential for acute monoarthritis. Dr. Joel Yaphe tells his Best Case Ever of a patient with septic arthritis as a bonus to Episode 16: Acute Monoarthritis. In the related episode Dr. Yaphe and Dr. Indy Ghosh discuss such questions as: What are the most important risk factors for septic arthritis? What are the most predictive signs and symptoms of septic arthritis? How does serum WBC, ESR and CRP contribute to the probability of septic arthritis? Should we still be performing arthrocenteses on patient's with overlying cellulitis? with an INR of 6? How can you tell the difference between septic bursitis and septic arthritis and how are they managed differently? What does the literature tell us about how useful the synovial fluid tests are in ruling in or ruling out septic arthritis? What is the role of bedside ultrasound in septic arthritis? Is there a role for steroid therapy in septic arthritis? When would you consider oral NSAIDs vs oral prednisone vs intra-articular methylprednisolone for the treatment of Gout? Is there a role for colchicine in the ED treatment of Gout? What is acute calcific arthritis of hydroxyapatite disease and why is it important for ED docs to know about? What is the most common cause of dermatitis-arthritis? How can one distinguish Reactive Arthritis from Septic Arthritis clinically, and how do their work-ups differ? Is there a role for antibiotics in Reactive Arthritis? How does gonococcal arthritis present compared with nongonococcal septic arthritis? and many more..... [wpfilebase tag=file id=378 tpl=emc-play /] [wpfilebase tag=file id=379 tpl=emc-mp3 /]
In Part 2 of this episode on Trauma Pearls & Pitfalls Dr. Dave MacKinnon and Dr. Mike Brzozowski go through key management strategies and controversies surrounding head, neck, chest, abdominal, pelvic and extremity trauma, followed by a discussion on how best to prepare the trauma patient for transfer to a trauma centre.
Nontraumatic Eye Emergencies are seldom very satisfying for the emergency physician to manage. However, with systematic approach and timely management they can save a patient's vision. Dr. George Porfiris and Dr. Simon Kingsley discuss four non-traumatic eye emergency presentations. The painful red eye, the painless red eye, acute painful loss of vision and acute painless loss of vision. Several cases are discussed in which an accurate diagnosis and timely ED management are of critical importance in order to prevent permanent vision loss and significant morbidity. A systematic approach to the eye examination is described with particular attention to important maneuvers such as the swinging flashlight test. The utility of ED ultrasound of the eye is debated, and a discussion around systemic diseases that cause eye problems provides fodder for many clinical pearls.
Dr. Eric Letovsky and Dr. Brian Steinhart describe a practical way to approach patients with undifferentiated SOB and acute congestive heart failure, the utility of various symptoms and signs in the diagnosis of CHF, as well as the controversies surrounding the best use of BNP and Troponin in the ED. A discussion of the use of ultrasound for patients with SOB as well as the indications for formal Echo are reviewed. In the second part of the episode they discuss the management of acute congestive heart failure based on a practical EM model, as well as the difficulties surrounding disposition of patients with CHF.