Osteomyelitis: The entire 5-part series
Here are the links for the entire five-part series on osteomyelitis. PART 01 / ETIOLOGY PART 02 / HISTORY + PHYSICAL EXAM PART 03 / LABS PART 04 / IMAGING PART 05 / TREATMENT
Osteomyelitis 05: Treat the children (with osteo) well
Let's move onto the final part in the osteo series - treatment. Editors note: small corrections were made on 3-14-14 with the addition of information of ortho consultation and the delay of antibiotics and changing cephalexin to cefazolin. Thanks to Dr. Indi Trehan for alerting me to the errata. Choosing the right antibiotic If you think its osteo, then start [...]
Osteomyelitis 04: Take a picture… It’ll last longer
By now you've likely seen parts one, two and three. Moving in a logical direction part four will focus on imaging, As you'd imagine, radiographic studies are supremely important in the diagnosis of osteo. Let's take a look by modality shall we? Plain films The bottom line is that it can take up to 2-3 weeks for the typical osteo [...]
Osteomyelitis 03: Lab ’em up
If you've been following along with parts 1 and 2, then part 3 is the next logical step- because, um, counting? Let's look at laboratory studies in osteo. It may come as no surprise that the initial labs that end up being most helpful are CRP, ESR and blood culture. Pääkkönen et al noted that both ESR and CRP were highly sensitive at [...]
Osteomyelitis 02: History & Physical exam
Welcome back to the Osteo series - Whereas part one focused mainly on etiology, part 2 delves into making the diagnosis with a good history and physical. I should really say that your history and physical helps increase your index of suspicion - since osteo can be quite elusive especially in the early stages. Harkening back to part one, it [...]
Osteomyelitis 01: I’ve got a bone to pick with you
Thus begins the PEMBlog series on Osteomyelitis. In each edition I'll tackle a different question - ranging from diagnosis to therapy and hopefully review most of the finer points. There is no better place to begin than at the start. Osteo as it will now be known (because I don't feel like typing the myelitis part) is a bacterial infection [...]
Clinical prediction models in community acquired pneumonia
Here is a summary of clinical prediction models in pediatric community acquired pneumonia and the signs and symptoms most suggestive of pneumonia. The take home point is that there is such a wide variability that you should only test/treat if your clinical suspicion is high. All four of these articles are worth a look. Lynch et al. - Pediatrics 2004 [...]
Summary of the high points of today’s pneumonia lecture
Check out the Storify summary of today's pneumonia lecture [View the story "February 21st pneumonia live tweet" on Storify]
What I’m reading: NG hydration in bronchiolitis – Really?
Certainly you will be seeing some sicker children with bronchiolitis this winter who have issues with feeding. The copious nasal congestion and increased work of breathing may preclude adequate oral intake. Some of these children will merit admission and generally we obtain IV access for hydration. But why can't we use their gut via a nasogastric tube? Logically this makes sense - [...]
Why we do what we do: Dexamethasone for croup
Something that I feel differentiates experienced from novice providers in the emergency department is a true recognition of the evidence and rationale behind why we do what we do. It is certainly important to recognize the right treatment for a given illness. Perhaps equally important it is necessary to understand the evidence behind the reason that treatment is given in [...]
