Clinical Question: Are ESR and CRP useful tests when evaluating an adult patient with potential septic arthritis?

Monoarthropathies are common and carry a broad differential including infection, trauma, lupus, rheumatoid arthritis, or crystal arthropathies.1–3 Of these, the can’t miss diagnosis is septic arthritis, as delayed treatment can cause irreversible joint destruction with a fatality rate up to 11% if not treated.4  Yikes. The Patient You are working in minor treatment and a 70-year-old gentleman presents with pain in his left knee that has been worsening over the past week.  It ...

The post Clinical Question: Are ESR and CRP useful tests when evaluating an adult patient with potential septic arthritis? appeared first on CanadiEM and was written by Aaron Sobkowicz.

CJEM Infographics: Antimicrobial treatment decision for non-purulent skin and soft tissue infections in the ED

This month CanadiEM is featuring an article from the Canadian Journal of Emergency Medicine (CJEM) that looks at the treatment of non-purulent skin and soft tissue infections (SSTIs) in the emergency department.1 Current practice patterns are highly variable between emergency physicians, with differences in the choice of antibiotic, duration of therapy, route of administration (oral or intravenous) and time to reassessment. Furthermore, the risk factors that predict the failure of oral antibiotics for SSTIs ...

The post CJEM Infographics: Antimicrobial treatment decision for non-purulent skin and soft tissue infections in the ED appeared first on CanadiEM and was written by Kevin Durr.

Trauma in a Hemophiliac

This case is written by Dr. Donika Orlich. She is a PGY5 Emergency Medicine resident at McMaster University who also completed a fellowship in Simulation and Medical Education last year.

Why it Matters

While Emergency physicians certainly see their fair share of trauma, managing a patient with hemophilia is quite infrequent. This case highlights some key management points, including:

  • The importance of administering early Factor VIII replacement
  • The need to monitor for delayed intra-cranial hemorrhage
  • The importance of determining capacity when a head-injured patient becomes agitated

Clinical Vignette

You are working in a level three trauma centre and are told that EMS just arrived from an MVC involving a 16-year-old female passenger who has known hemophilia. Vitals are stable. She has a laceration to her arm, and a bruise on her head, but has GCS 15 and only complains of arm pain.

Case Summary

A 16-year-old female presents following an MVC. Past medical history is significant for hemophilia A. She has a laceration on her arm and a bruise on her forehead, but denies HA/N/V. The learner should recognize high potential for bleeding, and implement immediate treatment with rVIII replacement, along with pan-CT imaging. The CT head will show a small ICH. The patient wants to leave AMA following normal CT results, and the learner must preform a capacity assessment and outline a plan of action for the incompetent patient. The patient should be sedated and/or intubated anticipating decline using neuroprotective measures. Consults should be made to the ICU and hematology.

Download the case here: Hemophilia Case

CXR for the case found here:

normal female CXR radiopedia

(CXR source: https://radiopaedia.org/cases/normal-chest-radiograph-female-1)

PXR for the case found here:

normal-pxr

(PXR source: http://radiopaedia.org/articles/pelvis-1)

Forearm x-ray for the case found here:

R forearm cropped

(X-ray source: http://www.auntminnie.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=56736)

ECG for the case found here:

sinus-tachycardia

(ECG source: https://lifeinthefastlane.com/ecg-library/sinus-tachycardia/)

FAST image for the case found here:

no FF

Cardiac U/S showing no pericardial effusion found here:

(U/S images courtesy of the McMaster PoCUS Subspecialty Training Program)


no PCE