Grand Rounds Summary 10.18.17

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Grand Rounds Summary 10.18.17

This week Dr. Gottula gave us a great in-depth explanation into alloimmunization and the use of RhoGAM in the ED. Dr. Owens and Faryar participated in a CPC centered around a sickle cell patient with knee pain. Dr. Asghar from orthopedics discussed the management of spine fractures in the ED. Our visiting professor Dr. Gail D'Onofrio discussed the ongoing opioid abuse issues facing the country. Dr. Hall discussed industrial injuries while Dr. Polsinelli wrapped things up with a discussion about how to use EMR to report core measures. 

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ESR, CRP, & Procalcitonin: Acute Inflammatory Markers in the ED

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ESR, CRP, & Procalcitonin: Acute Inflammatory Markers in the ED

Working in the ED one day you seem to hit a run of patients in whom consultants have asked you to order an ESR, CRP.  First, podiatry asked for them for a patient with 1st metatarsal osteomyelitis.  Spine surgery wanted the same for a patient with diskitis. And, ortho wanted them for a possible septic.  You think to yourself, “what am I or my consultant going to do with these test results?” “What are these inflammatory markers anyhow?” And, “what patient’s should I be ordering them in.”

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What is Useful in the ED to Help Diagnose or Rule Out Septic Arthritis?

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What is Useful in the ED to Help Diagnose or Rule Out Septic Arthritis?

History

There are many risk factors for septic arthritis including age >80, Diabetes, Rheumatoid Arthritis, recent joint surgery, prosthesis, cellulitis.  The absence of risk factors does not make septic arthritis less likely in an acute monoarticular arthritis

Physical

Monoarticular arthritis is often characterized as a warm, painful, swollen joint with limited range of motion.  No studies to date have quantified specificity data on the physical exam.  Therefore, clinicians must use their own clinical gestalt when interpreting physical exam findings.

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