“Afebrile patient with a swollen knee…” Case Conclusion May 7, 2012

Posted by Andy Jagoda, MD in: Uncategorized , trackback

The Conclusion Is…

You remembered from your evidence-based review of the literature that there is no serum blood test that can adequately rule out septic arthritis, so the patient’s history and exam warranted arthrocentesis. After laying the patient flat and partially flexing the knee with a pillow, you guided the needle medially under the patella and you aspirated watery, but cloudy, material. A point-of-care sLactate came back quickly at 15 mmol/L, and removed any ambiguity — this was a septic joint. While synovial culture and Gram stain (and blood cultures) were sent, along with sWBC and pre-op labs, you initiated IV antibiotics — vancomycin and ceftriaxone. Then you called up the orthopedist and asked him to prepare the OR.

Congratulations to  Dr. Lalitha, Dr. Averick, Dr. Karagöz, Dr. Piebalga, and Dr. Dube— this month’s winners of the exclusive discount coupon for Emergency Medicine Practice For an evidence-based review of the etiology, differential diagnosis, and diagnostic studies for Monoarticular Arthritis, purchase this issue.

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