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

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

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

Skin and soft tissue

Cellulitis and the role of laboratory

A 72 y/o woman presented to the ED for swollen and painful leg. Physical examination shows an erythematous, tender and warm leg. Probably it is a cellulitis. In previous post we stressed the US use to increase diagnostic accuracy. Can WBC or CPR help in the differential diagnoses? Do they have a role…

ByCiro Paolillo10 August 20120Comments

Chest

Thoracic trauma and chest X-Ray

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

ByIlenia Spallino10 July 20120Comments

Chest

Chest X-Ray and aortic dissection

A 70 yo man come to the ED for restrosternal chest pain and shortness of breath during minimal activity in the last days. He is an ex smoker, with a history of hypertension. On physical examination the patient is not in distress, with a regular blood pressure and regular oximetry. ECG shows no evidence of…

ByCiro Paolillo28 June 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

Chest

How LR works. Why any test is unnecessary for a patient with very low-risk chest pain?

A 40 yo truck driver, presented in ED with substernal chest pain. He is healthy, no family history of CAD. Held for observation, serial ECG have not modified, not elevated troponin. Is an Exercise Treadmill Testing useful (ETT)? Or a Myocardial Perfusion Imaging (MPI) is better? The pretest probability of CAD in this…

ByCiro Paolillo1 May 20120Comments

NO fever, NO bacteriaemia?

Atypical or typical, is this the question?

Pleuritic Pain, the end of the saga…

What does it hide behind a negative X-Ray?

Pleuritic pain and radio-occult lesion

Cellulitis and the role of laboratory

Thoracic trauma and chest X-Ray

Chest X-Ray and aortic dissection

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

How LR works. Why any test is unnecessary for a patient with very low-risk chest pain?

Septic Arthritis

Septic Arthritis and Arthrocentesis

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