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By vgreene, 29 January, 2015

Arrange out-pt f/u to ensure declining β-hCG levels [B]; instruct pt to return to ED for any concerning sx and strongly consider ruptured ectopic pregnancy4 [B]

By rray, 29 January, 2015

MRSA

(BMJ)—A 20-yo, healthy goat herder presented w/ 5 days of hemorrhagic bullae on her face that started as a painless, itchy papule; she had no systemic complaints. Exam: 3 lesions of hemorrhagic eschar surrounded by vesicles and brawny non-pitting edema. What is the diagnosis?

Bubonic plague

Cutaneous leishmaniasis

Cutaneous anthrax

Lymphocutaneous tularemia

Ecthyma

You are correct. Cutaneous anthrax was diagnosed by gram stain of vesicle fluid smear (showing large, gram-positive rods) and confirmed by culture. The lesion completely resolved after 14 days of IV penicillin. The source of infection was traced and found to be infected goats; some of them were dying. Exposure to infected animals or animal products is the most common means of transmission. The classic lesion is a painless papule that enlarges and ulcerates and develops a black eschar.

By vgreene, 28 January, 2015

Post-op: No brace if isolated ACL [M]. Prevent future ACL tear via NM training6 [M], not brace [L]. Initiate post-op PT7 [M]. Return to play based on clinical judgment, not time/fxn criteria [L].

By vgreene, 27 January, 2015

If repair ACL, also fix assoc meniscal tear [L], esp. if locked knee [C], but not assoc incomplete MCL tear [L]

By vgreene, 27 January, 2015

Initial operative mgmt, esp. if Δ laxity of IL vs CL knee3 >5-7 mm and pt active4 [L]. Techniques: tibial-independent/transtibial approach [M], single/double bundle [S], autografts or allografts5 OK [S]

By vgreene, 27 January, 2015

Initial conservative mgmt if Δ laxity of IL vs CL knee3 <5-7 mm and pt less active4 [L] w/ delayed repair if recurrent instability [L], goal <5 mo postinjury [M]

Arrange out-pt f/u to ensure declining β-hCG levels [B]; instruct pt to return to ED for any concerning sx and strongly consider ruptured ectopic pregnancy<sup>4</sup> [B]

MRSA

1502 DocAlert PDFs

Pediatric/skeletally immature w/ possible ACL tear

Consider ACL repair [L] vs conservative mgmt options:

Post-op: No brace if isolated ACL [M]. Prevent future ACL tear via NM training<sup>6</sup> [M], not brace [L]. Initiate post-op PT<sup>7</sup> [M]. Return to play based on clinical judgment, not time/fxn criteria [L].

If repair ACL, also fix assoc meniscal tear [L], esp. if locked knee [C], but not assoc incomplete MCL tear [L]

Initial operative mgmt, esp. if Δ laxity of IL vs CL knee<sup>3</sup> >5-7 mm and pt active<sup>4</sup> [L]. Techniques: tibial-independent/transtibial approach [M], single/double bundle [S], autografts or allografts<sup>5</sup> OK [S]

Initial conservative mgmt if Δ laxity of IL vs CL knee<sup>3</sup> <5-7 mm and pt less active<sup>4</sup> [L] w/ delayed repair if recurrent instability [L], goal <5 mo postinjury [M]

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