Chest Archivi - A life at risk

PCT and pneumonia: worth it?

A 78 yo woman is brought from an assisted-living facility because of dyspnea and fever. She has an history of dyabetes and heart failure. She is confused, tachipnoic, tachicardic and febrile with rales on the back. Chest X ray shows an infiltrate. PCT value is 1,5 µg/L. Does PCT provide prognostic information concerning mortality…

ByCiro Paolillo11 May 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

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

Chest

What does it hide behind a negative X-Ray?

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 Spallino27 October 20120Comments

Chest

Pleuritic pain and radio-occult lesion

A 33 y/o woman, comes to the ED because of a sudden emithorax pain localized on the left in basal region. The pain is described as stabbing, well localised, 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 Spallino11 October 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

PCT and pneumonia: worth it?

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

Useless ECG?

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?

What does it hide behind a negative X-Ray?

Pleuritic pain and radio-occult lesion

Can Ultrasound rule out a pneumothorax?

Septic Arthritis

Septic Arthritis and Arthrocentesis

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