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Lightning Lectures: Swollen Joint- Dr. Scott
- Septic arthritis: knee, hip, older- staph aureus, younger- gonorrhea
- Gout: negatively birefringent, needle-shaped monosodium urate crystals, consider precipitants, tx: NSAIDs, colchicine, 90%. have positive uric acid
- Pseudogout: positively birefringent
- Post-strep
- Traumatic
- Avascular necrosis
Arthrotomy- Dr. Angel
- Joint exploration, assess for extravasation of joint fluid (straw-colored)
- X-ray to assess for open fracture, foreign body in joint, intra-articular air
- Saline loading/methylene blue test vs CT scan
- Also assess joints with range of motion
- Tx: tdap, abx, ortho for washout in OR
Core US Topics- Dr. DiMeo, Dr. Nix
- Abdominal Aortic US
- Case: 72 yom h/o HTN, HLD, smoking presenting with left flank/lower back pain after lifting
- Curvilinear probe
- Orientation: find spine, aorta, and IVC
- Obtain views in proximal, mid, and distal aorta in both short and long axis
- Proximal aorta: celiac trunk with seagull sign
- Mid aorta: left renal vein and SMA anterior to aorta
- Distal aorta: bifurcation into iliac vessels
- Pitfalls: intestinal gas, BMI
- AAA: HTN, HLD, CAD, connective tissue disease; smoking (ever), age, sex (males)
- 90% infrarenal
- < 3 cm
- > 5.5 cm = immediate call to vascular
- Bladder US
- Assess bladder volume, post-void residual, foley placement, renal failure
- Landmark to pubic symphysis
- Bladder volume- height x transverse depth x width x 0.7
R2 Pathway: Low Back Pain- Dr. Lyons and Dr. Mattingly
- Consider red flag symptoms- trauma, age > 50, fever, immunocompromised, IVDU, recent surgery, epidural injection, urinary retention, abnormal reflexes, saddle anesthesia
- Fracture: CT scan, spine consult
- Malignacy: CBC, ESR, CRP, CT
- Cauda equina: emergent MRI, PVR, 10 mg decadron, spine consult
- Epidural abscess: CBC, ESR, CRP, Cultures, CT vs MRI; Vanc, flagyl, rocephin, spine consult
- Transverse myelitis: MRI, LP (high protein), neuro consult, steroids +/- PLEX
- Radicular back pain: no risk factors = no diagnostic imaging required
- 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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