A 3-year-old girl is brought to the emergency department by her parents because she has been refusing to walk since waking up this morning. The parents note she was entirely well yesterday but developed a fever overnight. On examination, her temperature is 39.2°C (102.6°F), heart rate is 130/min, and blood pressure is 95/60 mm Hg. She is holding her right leg in a flexed, abducted, and externally rotated position. She cries inconsolably with any passive range of motion of the right hip. There is no history of trauma.
Arrange the following steps in the most appropriate sequential order for the diagnostic and therapeutic management of this patient.
- 1Obtain plain radiographs of the right hip and pelvis
- 2Perform ultrasonography of the right hip
- 3Perform an arthrocentesis to obtain synovial fluid
- 4Administer empiric intravenous antibiotics
Cevap
The correct sequence is: 1) Obtain plain radiographs, 2) Perform ultrasonography, 3) Perform arthrocentesis, 4) Administer empiric intravenous antibiotics.
The correct sequence prioritizes non-invasive exclusion of trauma, followed by ultrasonographic confirmation of an effusion, definitive diagnostic sampling of that effusion, and finally, targeted antimicrobial therapy based on securing the culture.
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Anahtar Kavram
In a hemodynamically stable child with suspected septic arthritis, diagnostic joint aspiration must be performed before initiating antibiotics to prevent sterilization of the culture.
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