WORLD EMERGENCY MEDICINE SOCIETIES & RELATED

Search

Content:

Tuesday, October 11, 2016

Joint Fluid Analysis in the ED

TAMING THE SRU
Taming The SRU - October 10, 2016 - By Shaun Harty, MD

"...PUTTING IT ALL TOGETHER
  • For primarily inflammatory findings, keep in mind both crystal-induced arthropathies as well as other potential autoimmune causes like RA or SLE
  • Septic arthritis is NOT defined by >50,000/mm3 WBCs in the synovial fluid; use your clinical gestalt and the entire picture to define your diagnosis
  • Crystals in the synovial fluid does not preclude the joint from being septic
  • If a septic arthritis diagnosis cannot be reliably excluded after clinical evaluation, including arthrocentesis, admit the patient for IV antibiotics and pain control until culture results are available
  • Based on clinical suspicion, additional testing may be pursued including serum Borrelia burgdorferi DNA PCR and special staining and culturing for TB or fungal organisms"