Page 3 – A life at risk

Is it a subtle appendicitis? How to make time your friend

Mr. Smith is a 39 yo man with abdominal pain. He has been visited, few hours ago, by his primary care doctor who sent him to you for a surgeon consult. He refers abdominal pain, fever and nausea since the day before. The pain was previously in the midabdomen, than it migrated to the right…

ByCiro Paolillo11 August 20130Comments

Abdomen

Do you suspect a lower UTI? Urine analysis sometimes is over!

A 30 yo woman comes in ED complaining a burning pain when urinating, hematuria and increased of urinary frequency. She denies abdominal pain, fever, and vaginal discharge, she is not pregnant. On the right there’s the toilette – the nurse indicates – could you pee in this cup? Give me antibiotics – she says…

ByCiro Paolillo11 August 20130Comments

Head

Headache and Subarachnoid haemorrage. How and how long your pain started?

A young healthy man presents to the ED because of acute onset severe headheache. The pain has started the day before while he was swimming, he refers the worst headache of his life, neurological examination and vital signs are all normal. Head CT is also normal. After therapy and short clinical observation he feels better,…

ByIlenia Spallino11 July 20130Comments

Bones and joints

Sciatica: only pain control, or imaging? Point your big toe to your nose!!!

A 50 y/o friend of yours called for you. He refers low back pain radiating to his left leg from approximately 2 weeks. “help me doc - he says - I have a sciatica, a dog is biting my buttock, can you favor me with an urgent RMN?”. He is very suffering. During the straight…

ByCiro Paolillo11 July 20130Comments

Blood

Is it always necessary to perform an arterial blood gas after a blunt trauma?

A 53 year old man is involved in a motor vehicle crash. He refers a moderate thorax and abdominal pain. No head injury, the helmet is not broken, the patient remembers the accident. Systolic blood pression is 120/80 mmHg, respiratory rate is 24, saturation is 100%, he has abrasions over the torso and right thorax…

ByCiro Paolillo10 June 20130Comments

Chest

PCT and pneumonia: worth it?

A 78 yo woman is brought from an assisted-living facility because of dyspnea and fever. She has an history of dyabetes and heart failure. She is confused, tachipnoic, tachicardic and febrile with rales on the back. Chest X ray shows an infiltrate. PCT value is 1,5 µg/L. Does PCT provide prognostic information concerning mortality…

ByCiro Paolillo11 May 20130Comments

Abdomen

How have you come to the hospital?

It’s just started your night shift, Sara is a young EP, she is going home after an hard day. Hello - she says tired - could you help me? There is a guy with abdominal pain and nausea. I think it could be appendicitis, but there is not fever and not leukocytosis. Have you asked…

ByCiro Paolillo22 April 20130Comments

Abdomen

Imaging strategies of suspected acute colonic diverticulitis: how does it work?

A 66 yo man complains of left lower quadrant (LLQ) pain, anoressia and fever, it is the first time. The pain is acute, there is not vomit, temperature is 38°C. Abdomen is treatable, with severe pain and tenderness localized at LLQ , there is not history of prior abdominal surgery. Probably this patient suffers of…

ByCiro Paolillo10 April 20130Comments

Blood

To fill or not to fill? Try to raise the legs…

A 54 y/o man is brought to the ED because his wife has found him semiunconscious in the morning, he has not significant clincal history and does not take medicaments, he presents hypoperfused, arterial pressure is 90/50 and MAP is 63, lactate is 7 mmol/L and hemoglobin is 14 g/dl. Inferior vena cava diameter is…

ByIlenia Spallino2 April 20130Comments

The Emergency Physician

Is it a subtle appendicitis? How to make time your friend

Do you suspect a lower UTI? Urine analysis sometimes is over!

Headache and Subarachnoid haemorrage. How and how long your pain started?

Sciatica: only pain control, or imaging? Point your big toe to your nose!!!

Is it always necessary to perform an arterial blood gas after a blunt trauma?

PCT and pneumonia: worth it?

How have you come to the hospital?

Imaging strategies of suspected acute colonic diverticulitis: how does it work?

To fill or not to fill? Try to raise the legs…

Septic Arthritis

Septic Arthritis and Arthrocentesis

Is cervical spine X-ray necessary if there is a distracting injury?