Lightning Lectures: Swollen Joint- Dr. Scott

1. Septic arthritis: knee, hip, older- staph aureus, younger- gonorrhea
2. Gout: negatively birefringent, needle-shaped monosodium urate crystals, consider precipitants, tx: NSAIDs, colchicine, 90%. have positive uric acid
3. Pseudogout: positively birefringent
4. Post-strep
5. Traumatic
6. Avascular necrosis

Arthrotomy- Dr. Angel

1. Joint exploration, assess for extravasation of joint fluid (straw-colored)
2. X-ray to assess for open fracture, foreign body in joint, intra-articular air
3. Saline loading/methylene blue test vs CT scan
4. Also assess joints with range of motion
5. Tx: tdap, abx, ortho for washout in OR

Core US Topics- Dr. DiMeo, Dr. Nix

1. Abdominal Aortic US
2. Case: 72 yom h/o HTN, HLD, smoking presenting with left flank/lower back pain after lifting
3. Curvilinear probe
4. Orientation: find spine, aorta, and IVC
5. Obtain views in proximal, mid, and distal aorta in both short and long axis
6. Proximal aorta: celiac trunk with seagull sign
7. Mid aorta: left renal vein and SMA anterior to aorta
8. Distal aorta: bifurcation into iliac vessels
9. Pitfalls: intestinal gas, BMI
10. AAA: HTN, HLD, CAD, connective tissue disease; smoking (ever), age, sex (males)
11. 90% infrarenal
12. < 3 cm
13. > 5.5 cm = immediate call to vascular
14. Bladder US
15. Assess bladder volume, post-void residual, foley placement, renal failure
16. Landmark to pubic symphysis
17. Bladder volume- height x transverse depth x width x 0.7

R2 Pathway: Low Back Pain- Dr. Lyons and Dr. Mattingly

1. Consider red flag symptoms- trauma, age > 50, fever, immunocompromised, IVDU, recent surgery, epidural injection, urinary retention, abnormal reflexes, saddle anesthesia
2. Fracture: CT scan, spine consult
3. Malignacy: CBC, ESR, CRP, CT
4. Cauda equina: emergent MRI, PVR, 10 mg decadron, spine consult
5. Epidural abscess: CBC, ESR, CRP, Cultures, CT vs MRI; Vanc, flagyl, rocephin, spine consult
6. Transverse myelitis: MRI, LP (high protein), neuro consult, steroids +/- PLEX
7. Radicular back pain: no risk factors = no diagnostic imaging required
8. Nonspecific back pain: 85%, no labs required, can consider CBC, ESR, CRP, HCG
   • Imaging: CT better than XR, but does not assess spinal cord well, if concerned for spinal cord pathology > MRI; < 6 weeks of pain + no red flags = no immediate imaging
   • Treatment: heat/ice, remain active, light stretching
   • MMPC: NSAIDs, acetaminophen, lido patch, muscle relaxants
   • Trigger point injections