Early in my career prior to adopting ultrasound in my practice, I saw ortho delay because they were stuck in the O.R. telling us to hold off on antibiotics until they could come down and aspirate the hip. When they finally came down they were forced to do a hip aspiration blindly and coming up dry in a resuscitation-type situation because the child had gone into septic shock. This is why I learned how to do ultrasound guided hip aspiration (with im ketamine sedation if you need to), you can quickly get fluid for cultures and then promptly start antibiotics. No more worrying about these kids getting sicker and sitting on them doing nothing if ortho can't get to them in a timely fashion. The procedure is practically the same approach as doing a (long-axis/in-plane) ultrasound guided femoral central line but EASIER as you don't need to cannulate anything! The other issue is the small chance of MRSA septic arthritis and whether or not to cover with Vanco which why it's important to get the cultures prior to starting antibiotics.
Mount Sinai Medical Center
> Date: Wed, 16 Nov 2011 19:41:27 -0500
> From: [log in to unmask]
> Subject: Re: Septic Arthritis
> To: [log in to unmask]
> Question for the group - If you have a case that is highly suspicious for septic arthritis of the hip, in an otherwise healthy child, do you immediately start them on antibiotics or wait for Orthopedics to do a wash out or aspiration of the joint first? What if the child couldn't be taken to the OR that night, and instead was to be taken in the morning, some 8 hours later (because these things always present at 1am?) Would you still hold off on antibiotics until a sample was obtained? Just trying to see if standard of care was met by the ER for this case, and can't seem to pull up any clear cut evidence that it wasn't.
> Christopher KellyMedical DirectorPediatric Emergency MedicineNew York Methodist HospitalBrooklyn, New York
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