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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

Abdomen Blood

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

Abdomen

Does procalcitonin have a role in the management of acute appendicitis?

A 18 yo man comes to the ED in the morning because of low abdominal pain, fever and nausea. At palpation there is mild pain in the right inferior quadrant, not guarding. Could procalcitonin (PTC) helps to exclude quickly an acute appendicitis? Conclusion The figures are clear. We cannot use the PCT to…

ByCiro Paolillo10 October 20120Comments

Abdomen

Goodbye nasogastric lavage!

A 84 yo woman arrives in ED in midnight coming from a nursing because of a reported episode of coffee ground vomiting. Respiratory rate, heart rate and blood pressure are normal, abdomen is not distended, hemoglobin level is 10 g/dl. On rectal examination you find normal stool. She takes warfarin. Can a nasogasric…

ByCiro Paolillo10 July 20120Comments

Abdomen

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

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

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

Abdomen

Acute appendicitis and signs

A 21 y/o man presents to the ED with pain in right low quadrant (RLQ) , anorexia, nausea and vomiting. His abdomen is soft, with a mild tenderness in RLQ, the psoas sign is positive. The pain is aggravate by cough. You perform kindly a rectal examination with pain. Are this signs useful for the…

ByCiro Paolillo1 December 20110Comments

The Emergency Physician

How have you come to the hospital?

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

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

Does procalcitonin have a role in the management of acute appendicitis?

Goodbye nasogastric lavage!

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

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

Rectal Examination and Appendicitis

Bowel obstruction and physical examination

Acute appendicitis and signs

Septic Arthritis

Septic Arthritis and Arthrocentesis

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