Part Two: Mastering Wrist Arthrocentesis
We discussed the initial approach to the red, hot swollen wrist joint last month, and this month we focus on arthrocentesis of the joint with a full video of the procedure, including ultrasound and joint aspiration.A swollen, painful wrist that is hot to the touch with scant erythema is concerning for septic arthritis. The patient had multiple Band-Aids on his fingertips from blood glucose testing for diabetes, which increased his chances of having a septic joint with the punctures serving as an entry site for infection. Photo by Martha Roberts.The ProcedureIdentify the swollen joint, review the differential diagnosis, ...
Source: The Procedural Pause - May 1, 2020 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Part One: Tapping the Wrist
The wrist is not commonly aspirated in the emergency department, but emergent arthrocentesis may be indicated for extreme or concerning cases, and tapping the wrist to determine the underlying pathology or relieve pain may be of great value. The synovial fluid from the joint space can be analyzed for crystals, infection, and blood. This information may help determine the overall plan and aid in decision-making and consultation. The ultimate treatment plan may include admission, intravenous antibiotics, multiple aspirations, and even surgical washout.A swollen, painful wrist that is hot to the touch is concerning for sep...
Source: The Procedural Pause - April 1, 2020 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
LITFL Review 266
Welcome to the 266th LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chunk of FOAM.
The Most Fair Dinkum Ripper Beauts of the Week
Is EM a failed paradigm? Listen to two heavyweights in the field, Simon Carley and Scott Weingart delve into this challenging topic. [AS]
The Surviving Sepsis Guidelines have just been updated. Foamcast is here with an excellent summary of the n...
Source: Life in the Fast Lane - January 22, 2017 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs
MKSAP: 72-year-old man with acute swelling and severe pain of the right knee
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 72-year-old man is evaluated in the emergency department for acute swelling, severe pain, and warmth of the right knee that woke him from sleep. He does not recall any inciting injury to the knee. Three months ago, he had an acutely swollen great toe that improved within 3 days, for which he did not seek treatment. History is also significant for hypertension and diabetes mellitus. Medications are hydrochlorothiazide and metformin.
On physical examination, temperature is 37.8 °C (100.1 °F), blood pressure is...
Source: Kevin, M.D. - Medical Weblog - February 20, 2016 Category: Journals (General) Authors: mksap Tags: Conditions Rheumatology Source Type: blogs
Tap that Knee! Basics of Arthrocentesis
Part 2 of a Series
Our series on joint care has given you a basic overview on knee arthrocentesis. Typically, it is not necessary to have an orthopedic consultant come to the bedside in the emergency department to do this procedure. Arthrocentesis is a procedure you can do well and feel confident about your technique.
Take a moment to review our last blog post on knee pain before reading this post and watching the accompanying video. (http://bit.ly/1Q7dG4h.) As always, review the anatomy; it plays a key part in successful bedside technique. Ultrasound-guided arthrocentesis is always a favored approach.
Altho...
Source: The Procedural Pause - October 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Tap that Knee! Basics of Arthrocentesis
Part 2 of a Series
Our series on joint care has given you a basic overview on knee arthrocentesis. Typically, it is not necessary to have an orthopedic consultant come to the bedside in the emergency department to do this procedure. Arthrocentesis is a procedure you can do well and feel confident about your technique.
Take a moment to review our last blog post on knee pain before reading this post and watching the accompanying video. (http://bit.ly/1Q7dG4h.) As always, review the anatomy; it plays a key part in successful bedside technique. Ultrasound-guided arthrocentesis is always a favored approach.
Although em...
Source: The Procedural Pause - October 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Can I Tap That?
Part 1 of a Series
How often do you come in contact with a patient whose chief complaint is knee pain? How often can you actually to do something about it? Collectively as emergency providers, we do not typically fix these types of injuries in the ED, and at times, it is not even certain if we actually diagnose knee pain properly. The truth of the matter is simply that we can diagnose it correctly, help our patients feel better, and give them some answers.
Frequently, traumatic knee pain can be diagnosed as a contusion, generalized strain, or sprain. Rest, ice, compression, elevation, and NSAIDS are often presc...
Source: The Procedural Pause - September 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Can I Tap That?
Part 1 of a Series
How often do you come in contact with a patient whose chief complaint is knee pain? How often can you actually to do something about it? Collectively as emergency providers, we do not typically fix these types of injuries in the ED, and at times, it is not even certain if we actually diagnose knee pain properly. The truth of the matter is simply that we can diagnose it correctly, help our patients feel better, and give them some answers.
Frequently, traumatic knee pain can be diagnosed as a contusion, generalized strain, or sprain. Rest, ice, compression, elevation, and NSAIDS are often prescribed...
Source: The Procedural Pause - September 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Critical Care Compendium update
LITFL’s Critical Care Compendium is a comprehensive collection of pages concisely covering the core topics and controversies of critical care.
Currently there are almost 1,500 entries with more in the works… Some pages are more developed than others, and all the pages are being constantly revised and improved. Links to new references and online resources are added daily, with an emphasis on those that are free and open access (FOAM!).
These pages originated from the FCICM exam study notes created by Dr Jeremy Fernando in 2011, and have been updated, modified and added to since. As such will be particularly us...
Source: Life in the Fast Lane - November 17, 2013 Category: Emergency Medicine Doctors Authors: Chris Nickson Tags: Critical Care Compendium Education eLearning Emergency Medicine Featured CCC LITFL collection Source Type: blogs
MKSAP: 52-year-old man with gradually progressive left knee pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 52-year-old man is evaluated for a 5-year history of gradually progressive left knee pain. He has 20 minutes of morning stiffness, which returns after prolonged inactivity. He has minimal to no pain at rest. He reports no clicking or locking of the knee. Over the past several months, the pain has limited his ambulation to no more than a few blocks.
On physical examination, vital signs are normal. BMI is 25. The left knee has a small effusion and some fullness at the back of the knee; the knee is not erythematou...
Source: Kevin, M.D. - Medical Weblog - May 4, 2013 Category: Family Physicians Tags: Conditions orthopedics Source Type: blogs
Learning to think like a physician – module #2
Understanding system 1 helps us understand the common way experienced physicians approach diagnosis. But sometimes the patient's problem representation does not fit the physicians "toolbox" of illness scripts. We each have a collection of illness scripts to match against the problem representation. But sometimes we cannot easily make a good match. In those cases we must switch to system 2.
System 2 requires thought and a careful consideration of many possibilities. Descriptors include slow, deliberate, effortful, rule following, and conscious. When we discuss a pati...
Source: DB's Medical Rants - April 14, 2013 Category: Health Medicine and Bioethics Commentators Authors: rcentor Tags: Medical Rants Source Type: blogs
