osteomylitis next best step in management?

[amherstguy]

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if u suspect osteomylitis would u get an x-ray or go straight to a bone scan?
similarly if u suspect PE would you get a chest x-ray first or get a spiral ct/v-q scan first?

 

[RussianJoo]

if u suspect osteomylitis would u get an x-ray or go straight to a bone scan?
similarly if u suspect PE would you get a chest x-ray first or get a spiral ct/v-q scan first?

Don't you start antibiotics right away for Osteo? And then I think an X-ray is good enough to ID the bone pathology, which with your clinical and physical signs you can diagnose as osteo.

for PE you do a spiral CT, an x-ray won't show anything, and V-Q takes too long.

 

[registered user]

Xray is useless for osteo in the first two weeks. MRI is what you need. As to whether you choose MRI vs. antibiotics as your answer choice, that depends on the wording of the question.

 

[lord_jeebus]

For osteo I would get X-ray first (obviously start antibiotics without waiting for imaging) as the diagnosis can be made sometimes from plain film alone. If neg, follow-up with MRI (or triple-phase bone scan if MRI contraindicated).

If I suspect PE, obviously other lung pathology is also on my differential and I don't think I've ever gotten a CT angio on a patient without a prior or concurrent CXR.

 

[jabreal00]

For osteo I would get X-ray first (obviously start antibiotics without waiting for imaging) as the diagnosis can be made sometimes from plain film alone. If neg, follow-up with MRI (or triple-phase bone scan if MRI contraindicated).

If I suspect PE, obviously other lung pathology is also on my differential and I don't think I've ever gotten a CT angio on a patient without a prior or concurrent CXR.

If one is suspecting osteo; visible bone or stage 4 ulcer, get an MRI. Do not start an antibiotic until ortho has gone in there to get a sample. After that start something that has good Gram positive coverage and some anaerobes. The only time to start antibiotics before ortho starts debriding and getting a sample is if the patient is septic because usually the osteo is a subacute process and the patient will do fine holding off abx for 1 or two days. ---------------- Listening to: Death Cab For Cutie - I Will Possess Your Heart via FoxyTunes

 

[RussianJoo]

is this what the correct answer on step1/2 will be or is this what you would at your hospital? because those two things are often very different. I think the OP is asking what to answer on the test not what to do in practice.

 

[lord_jeebus]

is this what the correct answer on step1/2 will be or is this what you would at your hospital? because those two things are often very different. I think the OP is asking what to answer on the test not what to do in practice.

I took all 3 steps without ever seeing a question that I thought would differ in its correct answer from what would be done in my hospital.

If you think there's a difference, read the questions more closely for details that might separate them from the norm.

I agree that antibiotics can be held temporarily if the patient isn't septic - around my hospital they don't get motivated to come in until they get that way.

 

[RussianJoo]

ok thanks for your help.