›Immediate actions
›Monitoring
›Cardiac monitor if systemic illness
›Frequent vitals if unstable
›IV access
›If sepsis concern
›If procedural sedation possible
›Analgesia
›Acetaminophen PO 1000 mg once
›Ibuprofen PO 400 mg to 600 mg once if no contraindication
›Sepsis pathway triggers
›Lactate and blood cultures if unstable
›Early antibiotics after cultures when septic arthritis likely
›Diagnostic sequence
›Arthrocentesis priority
›Before antibiotics when stable and feasible
›Do not delay antibiotics if unstable
›Bloodwork selection
›CBC
›CRP
›ESR
›CMP
›Imaging selection
›X ray for trauma or chronic joint disease baseline
›Ultrasound for effusion detection and guidance
Antibiotics for suspected septic arthritis
›Antibiotics
›Timing
›After synovial and blood cultures when stable
›Immediate if septic physiology
›Empiric adult examples
›Vancomycin IV 15 mg/kg to 20 mg/kg
›Ceftriaxone IV 2 g daily if gram negative risk or gonococcal concern
›Special situations
›Prosthetic joint infection needs orthopedic and ID coordination
›Immunocompromised may need broader coverage local protocol dependent
Anti inflammatory and gout therapy
›Noninfectious flare therapy
›NSAID example
›Naproxen PO 500 mg once then 250 mg to 500 mg every 12 hours
›Avoid in CKD or GI bleed history
›Colchicine example
›PO 1.2 mg once then 0.6 mg 1 hour later
›Then 0.6 mg once or twice daily as tolerated
›Steroid example
›Prednisone PO 30 mg to 40 mg daily short course
›Avoid until septic arthritis excluded when concern present
›Consult and procedures
›Orthopedics
›High suspicion septic arthritis
›Prosthetic joint
›Need for operative washout
›Rheumatology
›Recurrent crystal disease
›Undifferentiated inflammatory arthritis
›Infectious diseases
›Bacteremia
›Unusual organisms
›Reassessment
›Timing
›Recheck pain and ROM after analgesia within 30 to 60 minutes
›Repeat vitals every 30 to 60 minutes if systemic concern
›Worsening triggers escalation
›Increasing swelling or erythema
›New fever
›Declining blood pressure
›Test follow through
›Synovial results review before disposition
›Culture follow up plan documented