In this week’s Grand Rounds, Dr. Polsinelli started us off with the diagnosis and management of aortoenteric fistula. We then discussed burnout and failure in our wellness curriculum in a small group setting, and heard from our colleagues in pharmacy about high-dose insulin therapy for calcium channel and beta blocker overdose. Dr. Roche led us in our Mastering Minor Care curriculum with a discussion of all things arthrocentesis, and we closed with a great combined PEM/EM simulation session and oral boards practice.Read More
Not all swollen joints are the same and our dogmatic definitions of septic joints are changing with each new study, so how do we use synovial fluid to define our differential of the swollen joint? Join Dr. Harty in delving through the latest in synovial fluid studies in his asynchronous intern diagnostics post on joint fluid analysis.Read More
Evidence Based Medicine on Tachydysrhythmias with Drs. Ludmer and Miller
- SVT is an umbrella term that includes AVNRT, atrial fibrillation and flutter, and polymorphic multifocal atrial tachycardia (MAT)
- AVNRT (AV Node Re-entrant Tachycardia) is the correct term for what is commonly diagnosed as SVT,
- MAT usually occurs in critically ill elderly patients with respiratory failure and is a poor prognostic sign, associated with 60% in hospital mortality. Treatment is to treat the causative pathology.
- REVERT Trial: Modified valsalva vs standard valsalva performed in 10 EDs with 428 patients in England. Findings included a 17% conversion with standard methods and 43% with the modified valsalva.
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
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.Read More