Emergency Radiology
Pneumonia
Lights criteria (High protein and LDH = exudate), determines presence of exudate with protein and LDH levels
- Pleural fluid protein to serum protein ratio >0.5
- Pleural fluid LDH to serum LDH ratio >0.6
- Pleural fluid level >2/3 of upper value for serum LDH
- Additional criteria – Confirm exudate if results equivocal
- Serum albumin – pleural fluid albumin <1.2g/dL
Hip Dislocation
- Early identification and reduction is key to prevent complications
- Always perform a full trauma and neuro exam, particularly of ipsilateral joints as concomitant injuries are common with traumatic dislocations
- Don’t be reassured by negative post-reduction XRs as small fractures can occur. You should always consider CT
CT before LP?
- If you think CT will show a cause for the headache, do a CT
- If a CT is indicated for other reasons (depressed conscious level, focal neurology), do a CT
- If a GCS 15 patient is to undergo LP for suspected (or to rule out) meningitis, and they have a normal neurological exam (including fundi), and are not elderly or immunosuppressed, there is no need to do a CT first.
- If you’re seriously worried about meningitis and are intent on getting a CT prior to LP, don’t let the imaging delay antimicrobial therapy.