EM Quick Hits 34 Carr’s Case, Septic Arthritis vs Transient Synovitis, Managing Tracheostomies, Ethylene Glycol Poisoning, Ketamine for Agitation

Topics in this EM Quick Hits podcast

David Carr the mighty return of Carr's Cases! (00:38)

Sarah Reid on differentiating septic arthritis from transient synovitis in pediatric limp (18:52)

Anand Swaminathan on managing tracheostomy complications in the ED (27:50)

Nour Khatib on rural medicine and ethylene glycol poisoning (37:52)

Justin Morgenstern on RCTs for ketamine in patients with severe agitation (48:17)



Podcast production, editing and sound design by Anton Helman

Written summary & blog post by Sarah Reid and Anton Helman November, 2021

Cite this podcast as: Helman, A., Swaminathan, A., Khatib, N., Reid, S., H. Carr, D., Morgenstern J. EM Quick Hits 34 - Carr's Case, Septic Arthritis vs Transient Synovitis, Managing Tracheostomies, Ethylene Glycol Poisoning, Ketamine for Agitation. Emergency Medicine Cases. November, 2021. https://emergencymedicinecases.com/em-quick-hits-november-2021/. Accessed [date].

Pediatric nontraumatic limp - differentiating transient synovitis from acute bacterial osteoarticular infection (septic arthritis, osteomyelitis)



* Age and fever dictate differential for nontraumatic pediatric limp



Causes of non-traumatic limp by age/presence of fever



* Workup to consider:



* Xrays

* CBCD, CRP, blood culture if infection/inflammatory cause suspected to help distinguish between transient synovitis and osteoarticular infection

* US (for effusion, soft tissues) if significant fever and/or elevation of inflammatory markers and/or severe pain

* MRI with gadolinium is the most accurate noninvasive test for osteoarticular infection and should be considered for patients with persistent pain/fever







Differentiating transient synovitis and acute bacterial osteoarticular infection



* Volume of blood matters when obtaining blood for culture and sensitivity which is essential, as hematogenous spread is common in children with osteoarticular infections





Expand to view reference list



* https://www.cps.ca/documents/position/osteoarticular-infections-in-children

* Peltola H. and Paakkonen M.  Acute Osteomyelitis in Children.  N Engl J Med. 2014;370:352-360.

* Tu J, et al. Test characteristics of history, examination and investigations in the evaluation for septic arthritis in the child presenting with acute non-traumatic limp. A systematic review. BMJ Open 2020;10:e038088.





Approach to tracheostomy emergencies in the ED

EM Cases Best Case Ever with Scott Weingart on Tracheo-innominate Fistula

Expand to view reference list



* First10EM Respiratory Distress in the Patient with Tracheostomy

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