Diverticula and Dislocations (Shoulder)
Hey Team,
Some things from last shift.
Antibiotics for diverticulitis?
The American Gastroenterological Association and the American College of Physicians suggest that routine antibiotics may not be necessary in select populations of immunocompetent patients with mild, uncomplicated disease with appropriate follow-up
This comes from the DINAMO RCT, where 480 patients with imaging-confirmed, uncomplicated diverticulitis whose symptoms were adequately controlled in the emergency department, outpatient treatment with or without amoxicillin-clavulanic acid resulted in similarly low rates of unscheduled return visits or hospitalization.
Can see REBELEM for their deeper dive on this study
Shoulder Dislocation
Although xray is often the go-to, you could reach for ultrasound to help diagnose a posterior shoulder dislocation and assess for appropriate reduction.
Please see this 5MINSONO video for review of this technique.
Some review of shoulder dislocation management and reduction techniques can be found here at COREEM.
There's the Cunningham technique for the cooperative, drama-free patient.
There's the FARES technique (which seemed to be the winner for our patient).
Be comfortable with multiple reduction techniques. No one approach will reduce all shoulder dislocations.
Remember to immobilize in a sling for 3-4 weeks and ensure appropriate orthopedic followup.
Cheers,
Dillon
References Cited:
Qaseem, A., et al. Diagnosis and Management of Acute Left-Sided Colonic Diverticulitis: A Clinical Guideline From the American College of Physicians. Annals of internal medicine, 175(3), 399–415. [pubmed]
Stollman, N., Smalley, W., Hirano, I., & AGA Institute Clinical Guidelines Committee (2015). American Gastroenterological Association Institute Guideline on the Management of Acute Diverticulitis. Gastroenterology, 149(7), 1944–1949. [pubmed]
Mora-López, et al. 2021. Efficacy and Safety of Nonantibiotic Outpatient Treatment in Mild Acute Diverticulitis (DINAMO-study): A Multicentre, Randomised, Open-label, Noninferiority Trial. Annals of surgery, 274(5), e435–e442. [pubmed]
