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Where is peritonitis?

A 80 YO man with a history of hypertension presents to the ED complaining of abdominal pain. He felt well until 8 hours ago, when he developed diffuse abdominal pain. The patient is afebrile, tachicardic, BP is 180/100 his lungs are clear, ECG shows no changes suggestive of ischemia. There is diffuse abdominal rigidity. In…

ByCiro Paolillo27 April 20150Comments

Bones and joints

Is my hand broken?

A 24 y/o guy presents in ED with the left hand upraised. “I fell off my bike yesterday – he says – I remember a serious impact with an outstreched palm.” There aren’t wounds, he feels pain on the radial side of left wrist, there is an anatomical snuffbox tenderness. The clamp sign is…

ByCiro Paolillo16 June 20140Comments

Abdomen

Clinical diagnosis of gastric ulcer. Does your gastroenerologist perform better?

A 35 yo smokerman presents at morning to the ED. He refers epigastric pain since seven days. The pain worses after eating, he refers nausea without vomit and he denies melena and weight loss. Palpation causes pain in epigastric region, there’s not fever, nor tachicardia, hemoglobin is 13 g/dL. Bedside US evidences a normal…

ByCiro Paolillo11 January 20140Comments

The Emergency Physician

Where is peritonitis?

Is my hand broken?

Clinical diagnosis of gastric ulcer. Does your gastroenerologist perform better?

Septic Arthritis

Septic Arthritis and Arthrocentesis

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