Episode Chapters
- Ureteral Colic17:22Asymptomatic HypertensionFree Chapter17:29Paper Chase #1 | iPhone Otoscopy Outperforms Traditional Otoscope5:15Sacral PainFree Chapter18:50SVC Syndrome17:11Paper Chase #2 | Acetaminophen Prevents Recurrence Of Febrile Seizure3:38What Would I Do Next? | Pancreatitis20:47Fast Track Pearls20:09Paper Chase #3 | Don’t Give Opioids For Ankle Sprains!5:39Child Abuse18:34DOAC Reversal20:27Hyperkalemia16:01Paper Chase #4 | Risk Of Biphasic Anaphylactic Reactions Is Low3:49Excellence in the Physical Exam Series: Alcoholics11:46Paper Chase #5 | Don’t Miss Pediatric Anaphylaxis4:46The Summary13:02
Sacral Pain
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Miz and Mike talk to Dr.Rajesh Geria to discuss a case of a young woman with sacral pain. After multiple misdiagnosis, the pt was ultimately diagnosed with a pilonidal cyst. They discuss the importance of a focused exam, particularly looking at the area of concern. Also management of this diagnosis is discussed.
Pearls:
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Patients with pilonidal cysts should be referred to a general surgeon for definitive management and removal.
Differential Dx For Sacral Pain
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Musculoskeletal sprain/strain
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Cauda equina
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Epidural abscess
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Fracture
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Constipation
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Menses
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Herpes zoster
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Pilonidal cyst
Background - Infected Pilonidal Cysts
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A pilonidal cyst is essentially a sac filled with debris and hair trapped under the skin of the sacral region.
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It is more common in men, young people, patients with heavy hair growth and patients with a family history of pilonidal cysts.
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It can be secondary to strep and staph in addition to anaerobes.
Management - Infected Pilonidal Cysts
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Like all abscesses, the mainstay in management is incision and drainage. Needle aspiration is not sufficient to adequately drain these abscesses.
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Infected pilonidal cysts can be particularly foul smelling so use suction to keep the odor to a minimum.
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Patients should be referred to a general surgeon who will remove the cyst as an outpatient to prevent occurence.
Ian L., Dr - July 17, 2019 5:07 AM
What about Intramuscular ketamine in urgent care ?
Mike W., MD - July 17, 2019 3:30 PM
I think there are experienced providers who feel comfortable w this... but... this is certainly not something that I think is being commonly done. There are some subtleties with dosing as well as reactions to ketamine which need to be appreciated before using in this setting.
Mike W., MD - July 17, 2019 3:30 PM
I think there are experienced providers who feel comfortable w this... but... this is certainly not something that I think is being commonly done. There are some subtleties with dosing as well as reactions to ketamine which need to be appreciated before using in this setting.