Page 6 – A life at risk

Is CRP correlated to CT result in the evaluation of abdominal pain?

A 74 yo/man complained of diffuse abdominal pain. The pain was intermittent and accompained by vomiting. He has no history of abdominal pain or abdominal surgery. On examinations the patient presented non icteric, afebrile, not tachicardic. The abdomen was mildly distensed with midline tenderness. The US evidenced a normal aorta diameter. Abdominal…

ByCiro Paolillo10 May 20120Comments

Chest

How LR works. Why any test is unnecessary for a patient with very low-risk chest pain?

A 40 yo truck driver, presented in ED with substernal chest pain. He is healthy, no family history of CAD. Held for observation, serial ECG have not modified, not elevated troponin. Is an Exercise Treadmill Testing useful (ETT)? Or a Myocardial Perfusion Imaging (MPI) is better? The pretest probability of CAD in this…

ByCiro Paolillo1 May 20120Comments

Abdomen Ultrasound

Does Murphy’s sign and sonographic Murphy sign have the same clinical utility?

A 40 yo woman presented to the ED with upper quadrant pain since three hours after eating a tasty pizza. She is overweight, she presents feverish (38°C) her skin is nonicteric. The abdomen is soft, there is tenderness on the upper right quadrant, you perform a deep palpation in the subcostal area, and the patient…

ByCiro Paolillo15 April 20120Comments

Chest Ultrasound

Diagnosis of pneumonia. Is it the time for a combined imaging strategy?

A 80 yo man is brought from an assisted-living facility because of fever, productive cough, tachycardia and dyspnoea. He has a history of dementia and hypertension. He is cachectic, you hear ronchi on the left side. How should you approach this patient? In the Emergency department setting the pretest probability of pneumonia…

ByCiro Paolillo5 April 20120Comments

Abdomen

Rectal Examination and Appendicitis

A 25 y/o man comes to the ED because of abdominal pain started 2 hours before, fever and vomit. He has not history of disease, no history of surgery, no history of other ED admission for abdominal pain. Clinical examination shows rigidity and diffused painfull abdomen. You perform digital rectal examination were you evidence no…

ByIlenia Spallino18 March 20120Comments

Abdomen

Bowel obstruction and physical examination

A 75 y/o man arrives in ED from a nursing. He complains abdominal pain. No fever, no jaundice, abdomen presents distended. Inspection shows a midline old scar, there is diffuse rigidity, increased bowel sounds and vomit on the sheets. Can history and clinical examination contribute to diagnosis of bowel obstruction? …

ByCiro Paolillo10 February 20120Comments

Bones and joints Ultrasound

Septic Arthritis and Arthrocentesis

A 33 y/o male comes to the ED for fever, knee swelling and pain. He has a history of joint surgery because of trauma, and prothesis, dating 4 years before. He is HIV positive He presents feverish (38°C), the left knee is swollen and hot. WBC 34.000/μL, CRP 109 mg/L, PCT 0,05 ng/mL. As we…

ByIlenia Spallino26 January 20120Comments

Bones and joints

Septic Arthritis

A 33 y/o male comes to the ED for fever, knee swelling and pain. He has a history of joint surgery because of trauma, and prothesis, dating 4 years before. He is HIV positive He presents feverish (38°C), the left knee is swollen and hot. WBC 34.000/μL CRP 109 mg/L PCT 0,05 ng/mL Are history,…

ByIlenia Spallino18 January 20120Comments

Skin and soft tissue Ultrasound

Soft tissue abscess: clinical plus ultrasound evaluation

Male 65 y/o, he complains pain and swelling in left groin, he has history of hypertension. He has not fever. Clinical examination shows swelling, skin is hot and eritematous. Is it an abscess, a cellulitis or something else? Conclusion To use ultrasound on eritematous and swelling skin is very helpful Abscesses presents…

ByCiro Paolillo8 January 20120Comments