Conference Summary 7/13

Diabetic foot infections
1) Diabetic foot cellulitis - it comes from ulcers, if there is/was no ulcer, it's likely not cellulitis.
2) Limb-threatening diabetic foot infections - cellulitis extending >2cm from ulcer, probes to bone
3) Charcot foot - occurs in stages, no systemic symptoms, labs will likely be normal. 45% mortality in 4 years.

Orthopedic pearls/orthopedic lab
1) Shoulder dislocations -  anterior dislocations are the most common, and most of those are subcoracoid dislocations.  Least common dislocation is an inferior dislocation - aka luxatio erecta - the arm will be locked in abduction.  
2) Nursemaid's elbow - reduce by supinating the child's forearm with the elbow flexed and apply pressure over the radial head.  You should hear a 'click' as the annular ligament is liberated from the joint.

CIWA
1) Withdrawal seizures - you should not need a lot of benzodiazepines to control alcohol withdrawal seizures.  If the patient requires escalating doses of benzodiazepines to control seizures, consider additional seizure etiologies.
2) CIWA score - it is not diagnostic of alcohol withdrawal, just a severity score.  Diagnose withdrawal based on signs and symptoms in the right context. The patient must be able to participate in questioning as 4 out of the 6 categories necessitate answers from the patient.
 
Dissociated ramblings - attachment from ASA (short read, funny)
1) Achilles ultrasound - sensitivities and specificities vary from paper to paper, however, you can use it to diagnose Achilles' tendon rupture.  One difficulty with tendon ultrasound is a sonographic artifact called anisotropy.  This occurs when the probe is not perpendicular to your higher-than-average refractive structure (ex: tendon) and will cause the structure to appear hypoechoic. 
2) Local anesthetic toxicity (LAST) - the more lipophilic, the more potent the local anesthetic (the uncharged drug must penetrate nerve membrane as well as bind to a hydrophobic site on the sodium channel).  If systemic toxicity occurs, you can consider giving lipid emulsion as a reversal agent.  Lipid rescue is a big area of research in toxicology.