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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 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 Ultrasound

Can Ultrasound rule out a pneumothorax?

Y ou are allerted for a level 3 trauma from the mountain, a cyclist has fallen going down hill. You prepar the shock room with everything you may need, dress up, and wait. A 25 y/o cyclist arrives completely immobilized, you immidiately start to perform ABCDE as you learned in your recent ATLS course (you…

ByIlenia Spallino10 July 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

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

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

Chest Ultrasound

Acute dyspnoea and Lung Ultrasound

It's a dark night when a red code arrive at the ED by ambulance. Paramedics tell you: “called for acute dyspnoea, I think it’s a COPD exacerbation, he is wheezing, I gave him bronchodilators and steroids, but he is worsening”. He has a history of COPD and hypertension. He presents sweaty, dyspneic, arterial…

ByIlenia Spallino31 October 20110Comments

The Emergency Physician