›Time critical stabilization
›Escalate to resuscitation bay for hypotension or altered mental status
›Sepsis protocol if suspected systemic infection
›If airway compromise, then airway management
›Post intubation sedation and analgesia to target comfort
›If shock, then IV crystalloid bolus 20-30 mL/kg
›Norepinephrine infusion if MAP < 65 mmHg after fluids
›Pain control plan prior to joint procedures
›If severe pain, then IV opioid titration with monitoring
›Early diagnostic and source control plan
›Arthrocentesis priority before antibiotics when feasible
›If unstable or high sepsis risk, then antibiotics not delayed for aspiration
›Blood cultures x2 before antibiotics if feasible
›If antibiotics already given, then still obtain cultures
›Early orthopedic consultation for suspected septic joint
›Immediate consultation for hip, shoulder, prosthetic joint, or rapid clinical decline
›Key concepts
›Septic arthritis as joint space infection with rapid cartilage destruction
›Irreversible damage possible within 24-48 hours without drainage and antibiotics
›Diagnosis anchored on synovial fluid studies
›Culture as definitive test
›Drainage as essential therapy
›Repeated aspiration vs arthroscopic or open washout based on joint and response
›High risk features
›Hemodynamic instability
›Lactate elevation or rising trend
›Hip involvement
›Limited range of motion with inability to bear weight
›Immunocompromised state
›Neutropenia or high dose steroids or transplant
›Prosthetic joint
›Early postoperative infection concern
›Overlying cellulitis with systemic signs
›Necrotizing infection concern if pain out of proportion