Trick of the Trade: Knee Arthrocentesis

arthrocentesis2A patient comes into the ED and you suspect septic arthritis to the knee. As you consent the patient for arthrocentesis, you can tell s/he has reservations about a needle being inserted into their knee and left in place while you aspirate. You also think in the back of your mind how tricky it is to sometimes change syringes while keeping the needle in the correct location. Is there another way of tapping the knee without a needle?

 

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High risk back pain: Spinal Epidural Abscess

epidural-abscess-282x300-modifiedSpinal epidural abscess (SEA) is a rare but potentially catastrophic cause of back pain. Classically these patients are described as having back pain, fever, and clear neurologic deficits. In reality, patients often present with less obvious symptoms which often leads to a delay in diagnosis. Missed cases of SEA are a source of significant risk to both the patient and the provider. To improve outcomes and minimize risk, providers must identify and promptly evaluate patients who are at increased risk of developing a SEA.

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2016-11-12T09:28:24-07:00

Sternoclavicular Joint Dislocations: Diagnosis and Treatment

Image obtained from healio.com

A 16-year-old football player presents to the emergency department directly from a game. He was tackled, falling onto his right shoulder. The patient is complaining of right-sided chest pain. On exam, there is tenderness over the right sternoclavicular joint (SCJ) with a prominent medial clavicle. Range of motion is limited in the right arm. What diagnostic studies need to be performed? What treatment is warranted in the emergency department?

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2019-02-06T20:11:22-07:00

High risk back pain: Cauda Equina Syndrome (EREM)

cauda-equ-disc11Cauda equina syndrome (CES), which occurs due to compression of the distal lumbar and sacral nerve roots, is a potentially devastating cause of back pain. CES is often missed on the patient’s initial visit which can lead to  significant neurologic compromise in a matter of hours [1]. To improve patient outcomes and minimize medicolegal risk, providers need to understand the limitations of the history and physical and carefully consider the diagnosis of CES in any patient with back pain.

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2016-12-20T11:19:57-07:00