Septic arthritis of the hip
-Most common hematongenous spread
- Up to 20% of patients with non-gonococcal septic arthritis will have 2 or more joints involved –> always do a full musculoskeletal exam!
- 50% will have positive blood cultures –> always obtain cultures.
- Risk factors: Extremes of age, hardware/recent instrumentation, skin infection, underlying arthritis, IV drug use
- You cannot rule out septic arthritis with inflammatory markers or any physical exam findings, so err on the side of obtaining joint fluid.
Pediatric septic arthritis vs. transient synovitis
- Kocher criteria can help differentiate: Temperature >38.5, WBC >12K, ESR >40, unable to bear weight.
The Role of the ECG in Acute Nontraumatic BLE Weakness
Acute bilateral lower extremity paralysis
Hypokalemic periodic paralysis
I. Familial hypokalemic periodic paralysis
ECG signs of severe hyperkalemia
Pediatric pericardial effusion/pericarditis
1) Kids with chest pain also hide gremlins
2) Consider bedside echo for all pediatric chest pain visits!
3) Effusions of 500cc, circumferential, or 2 cm on CT scan are by definition LARGE and likely mandate admission and stat echo looking for tamponade
4) Ultrasound guidance for bedside pericardiocentesis is the new standard
5) Be vigilant in sign outs, always add an update note
Abdominal pigtail placement
1) Small bore seldinger technique makes abdominal placement more likely, you can't finger sweep
2) Consider clamping the introducer needle at the skin once air is aspirated to avoid unintentional advancement
3) Remember the triangle of safety, go as high as possible with pigtails
4) In the event of an abdominal mishap, scan the region and discuss with surgery
Headache with ICH/IVH
1) Be wary of the "different" migraine
2) Deep brain structure bleeding is associated with intraventricular extension
3) IVH carries a 20-50% in hospital mortality
4) ABCs, potential emergent EVD placement
5) Even though a CT head is negative within the window, the LP may give you additional information that makes the diagnosis (opening pressure, cell counts, etc)
Case Reports & Case Series: Strengths, Weaknesses, and “How-To” of this low hanging fruit - Dr. PATTERSON
1: Case reports and case series are foundational to clinical research.
2: Case reports and case series provide the opportunity for clinicians to describe novel clinical management and treatment of patient case(s).
3: Case reports and case series provide clinicians to offer “clinical pearls” to trainees and junior clinicians.
4: Despite inability to perform hypothesis tests, case reports offer the opportunity clinician investigators to develop a command of a clinical condition/disease state and treatment/management protocol.
Define status epilepticus:
Remember ABCs and supportive care in addition to treating seizures
Learn dosing for hypoglycemic seizure with dextrose
Learn dosing for hyponatremia seizure with 3% NaCl