Conference Notes 8/14

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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

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