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Emergency Medicine Cases

Best Case Ever 5 Septic Arthritis

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7602 Ratings

🗓️ 19 July 2011

⏱️ 5 minutes

🧾️ Download transcript

Summary

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 /]

Transcript

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0:00.0

This month's best case ever is in anticipation of episode 16 called Hot Joints What to Do.

0:24.0

And we have with us Dr. Joel Yaffey, who's going to tell us about his best case ever related to hot joints.

0:31.2

Dr. Yaffey, let it rip.

0:32.8

Okay.

0:33.6

So why is this my best case ever?

0:35.6

This was, for me, a real learning experience in many ways,

0:39.2

and it also reinforced some stuff that I think I knew at advance. So this was a guy who actually

0:45.2

I saw about two weeks ago now, man who was about 65 years old, a diabetic whose wife came

0:53.3

home in the morning after she went shopping and came to find him slumped over at the table, awake but looking quite ill.

1:00.3

Brought into our emerge, had a temperature of 40 degrees.

1:04.6

He was awake, but really not answering questions well.

1:09.0

And our history that we could get suggested that the guy had been

1:13.0

pretty well in the past week, although there might have been a bit of a history of a respiratory

1:18.1

tract infection. We examined him. We did the usual tests looking for a source of sepsis. We did a chest

1:26.1

x-ray, a urinalysis, lactate was eight. We

1:30.7

fluid resuscitated him. We gave him broad spectrum antibiotics to cover him for everything

1:36.6

possible. ICU came down and saw him and despite fluid resuscitation, he really didn't look great, so I ended up going to the ICU.

1:47.7

When I followed him up the next day, I found out that his diagnosis was septic arthritis,

1:54.5

and he was taken urgently to the OR.

1:57.9

What happened?

1:59.1

Well, by the time the next morning rolled around, he was fluid resuscitated

2:03.5

and feeling better, and at that point, he started complaining about his right knee. And when people

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