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NO fever, NO bacteriaemia?

A 80 yo nursing home resident woman is brought to the ED by ambulance. “Hypothension, cough and a hystory of heart failure ”, refers the nurse. She looks pale and confused, her respiratory rate is 22, oxygen saturation on room air is 90%. Ear temperature is 36,5°C, BP is 90/60 mmHg, HR is…

ByCiro Paolillo24 October 20140Comments

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

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

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

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

Blood

CD4 and Lymphocyte count

A 30 yo man from Zambia comes to the ED accompained by his girlfriend, he is HIV positive and he has pneumonia, he never done CD4 count. CD4 count of < 200 signifies a greater risk for opportunistic infections = recovery. I can’t wait for the reponse of the CD4 count… How much an absolute…

ByCiro Paolillo12 July 20110Comments

The Emergency Physician

NO fever, NO bacteriaemia?

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

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

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?

CD4 and Lymphocyte count

Septic Arthritis

Septic Arthritis and Arthrocentesis

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