Page 4 – A life at risk

Diagnosis of diverticulitis with hands and blood tests. Is it a good idea?

A 66 yo man complains of left lower quadrant (LLQ) abdominal pain from 4/5 hours. The pain is described as crampy initially, than continuous, there is not vomit. Temperature is 37.5°C. Abdomen is treatable, with moderate pain and tenderness localized at LLQ , there is not history of prior abdominal surgery. ED US excluded the…

ByCiro Paolillo7 March 20130Comments

Blood

Is CRP useful alone to support the hypotesis of a bacteremia?

I t’s a very cold February, but ED is very hot in every sense of the word. A 22 y/o student refers stomach pain, chills, fever and diffuse muscolar pain. He has fever (38° C) there is a mild diffuse abdominal pain. The CRP value is 30 mg/L. Are there flu symptoms,…

ByCiro Paolillo25 February 20130Comments

Blood

Malaria or just fever?

A 35 y/o man is brought to the ED by friends and left there alone, he has high fever, he is from Ghana and he has just arrived, he speaks english not so well and he is confused and agitated, so anamnesis is very difficult and you catch a only word “malaria”, you also know…

ByIlenia Spallino16 February 20130Comments

Chest Ultrasound

Is chest X ray necessary to rule out PNX after thoracic maneuvers?

I t’s a busy day in ED this morning. The first patient refers dyspnoea, he has an advanced pulmonary neoplasia, ultrasound and chest x-ray confirm that the left zone is occupated by a pleural effusion. The thoracentesis removes about 1.5 liter of fluid, the patient breathes easily. The second patient is 65 yo, he…

ByCiro Paolillo4 February 20130Comments

Chest

Useless ECG?

A 67 y/o man arrives to the ED by ambulance because of precordial pain since half an hour, during the transport, paramedics perform an ECG that shows a left bundle branch block (LBBB), that patient refers in his history. They find it unuseful and so they do not transmit it to the cardiologist, is it…

ByIlenia Spallino15 January 20130Comments

Bones and joints

Is it broken?

A nthony, a 15 y/o student, slipped and fell while playng soccer. The next morning he refers continue pain on the right elbow. “Is it broken?” ask Anthony and his father at the triage desktop? There is pain and edema near the elbow, no radial pulse deficit, he can fully extend and flex the articulation,…

ByCiro Paolillo7 January 20130Comments

Chest

Atypical or typical, is this the question?

I t is a busy day in your ED: A 60 y/o female refers a retrosternal pain radiates to right arm that lasts more than 20 minutes. A 50 y/o male refers a pressure in his chest, with tachycardia and sweating. A 75 y/o female refers a sharp and stabbing pain exacerbates by forceful breathing.…

ByCiro Paolillo8 December 20120Comments

Chest Ultrasound

Pleuritic Pain, the end of the saga…

A 33 y/o woman, comes to the ED because of a sudden emithorax pain on the left in basal region. The pain is described as stabbing, well localized, it worsen with inspirium …a pleuritic pain, no cough, no fever, not hemoptysis. She smokes, she does not take any medication. Chest x ray is normal.…

ByIlenia Spallino17 November 20120Comments

Chest

Can we fight against Pulmonary Embolism using the LR’s arrows?

A 80 y/o woman presented to the ED for dyspnoea. She underwent a knee replacement 2 weeks ago, RR is 24, O2 saturation is 88%. HR is 90, the knee is edematous. You are going to hunt a pulmonary embolism (PE) While you phone the radiologist for a thorax CT scan you have an idea:…

ByCiro Paolillo31 October 20120Comments

The Emergency Physician

Diagnosis of diverticulitis with hands and blood tests. Is it a good idea?

Is CRP useful alone to support the hypotesis of a bacteremia?

Malaria or just fever?

Is chest X ray necessary to rule out PNX after thoracic maneuvers?

Useless ECG?

Is it broken?

Atypical or typical, is this the question?

Pleuritic Pain, the end of the saga…

Can we fight against Pulmonary Embolism using the LR’s arrows?

Septic Arthritis

Septic Arthritis and Arthrocentesis

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