Emergencies Flashcards
(38 cards)
Which joint is usually implicated in septic arthritis?
Knee 75%
What are the causes of septic arthritis?
Staph Aureus: Single site, MOST COMMON Strep: Multiple sites HiB: Multiple sites Gonorrhoea: Sexually active Anaerobic organism: Penetrating trauma
What are the RFs for septic arthritis?
Steroids RA IVDU Prosthesis DM ImmunoS
What can septic arthritis result from?
Adjacent osteomyelitis
Haematogenous spread
Puncture/direct trauma
How does septic arthritis present?
Single joint Swollen Hot Erythematous Painful & tender ↓RoM- Stiff Held in slight flexion for comfort Systemic: Fever, rigors, hypoT, Tachy, vomiting
How is a septic joint investigated?
Aspiration: MC&S, Gram stain, culture
Bloods: Cultures, FBC (↑WCC), ↑CRP
Xray: Widened joint space, ST swelling, effusion, erosion (LATE)
USS deep joint
Bone scan: If multiple sites
How is septic arthritis treated?
START IV Abx as soon as aspiration sent
1) Abx: Fluclox/Vancomycin, Cefotaxime (Gonococcal)
2) Splinting
2) Surgical debridement
4) Physio
What are the complications of septic arthritis?
Bone destruction <24hours
Chondrolysis
What is temporal arteritis?
Immune mediated granulomatous vasculitis of Medium & Large vessels
What are 50% of temporal arteritis’s associated with?
Polymyalgia rheumatica
Who is typically affected by temporal arteritis?
Female >55yo
if Female <55yo = Takayasu’s
What are the Sx of temporal arteritis?
Rapid onset <1m Diffuse constant headache Unilateral- 85% Superficial pain over temporal region Scalp tenderness Jaw claudication Distended, throbbing temporal artery Acute transient visual loss- 10% Other: N&V, night sweats, ↓weight
How is temporal arteritis investigated?
Bloods:↑↑ESR > 40, ↑↑CRP, , ↓Hb, ↑WCC, ↑ALP
Temporal artery biopsy: Within 7d of starting steroids, if skip lesions = DEFINITIVE DIAGNOSIS
How is temporal arteritis treated?
Steroids: IMMEDIATE, Prednisolone 40mg for 2yrs URGENT REFERAL to opthalmology- Same day Consider: PPI: Gastroprotection Bisphosphonates
What criteria can be used to diagnose temporal arteritis?
GCA Classification 3/5:
- > 50yo
- New headache: New onset, new type, localised pain
- Temporal artery abnormality: Tenderness on palpation, ↓ pulsation
- ↑ESR >50
- Abnormal artery biopsy: vasculitis, granulomatous inflammation, multinucleate giant cells
What are the complication of temporal arteritis?
Stroke/TIA
Visual loss- Temporal artery involvement
How does spinal cord compression occur?
Direct spinal cord pressure or induction of vertebral collapse
Leads to SC or caudal equine compression
Neurological instability
Where does SCC typically occur?
66% thoracic
33% lumbar
What are the causes of SCC?
- Malignancy: Extradural mets (Prostate, breast, lung, myeloma, lymphoma), extension of tumour from vertebral body
- Trauma: crush #, transection or hemisection from penetration, prolapsed disc
- Inflammatory: RA (high cervical spine compression)
Where do prolapsed discs commonly happen?
L4-5
L5-S1
What are the Sx of SCC?
90% Back pain: Localised, nocturnal,
Motor: Weakness/pain, subtle onset 3m before Neuro Sx
Sensory: Paraesthesia, numbness, saddle anaesthesia
Bowel/bladder Sx
How is SCC investigated?
?SCC = URGENT WHOLE SPINE MRI <24hours
Neuro: CNS & PNS ALL 4 limbs
Palpate spine for tenderness
Anal tone
What happens to reflexes in SCC?
↑BELOW compression
ABSENT at level
NORMAL above level
How is SCC treated?
1) Dexamethasone 16mg + PPI
2) Analgesia
3) Surgery/RT
Stabilise & immobilise spine
LMWH if admission
Catheterise if retention
