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Ottawa ankle rules. Does it really work?

A 16 yo guy is brought in ED by his mother after a scholar accident. While he was running, he crashed. My son has a sore ankle! Is it broken? Asks the mother seriously worried. The ankle his slightly tumefied, there isn’t bone tenderness at the posterior edge or tips of either malleolus,…

ByCiro Paolillo11 April 20140Comments

Abdomen

Plain X ray in suspected bowel obstruction. Is that all?

A 67 y/o woman arrives in the ED at 5pm because of diffused abdominal pain since 2 hours. She has nausea and she refers costipation from the day before. She has a history of hysterectomy 5 years before because of fibroma. Vital signs are normal, she presents pale and sufferer for pain, the abdomen…

ByIlenia Spallino11 November 20130Comments

Head

Headache and Subarachnoid haemorrage. How and how long your pain started?

A young healthy man presents to the ED because of acute onset severe headheache. The pain has started the day before while he was swimming, he refers the worst headache of his life, neurological examination and vital signs are all normal. Head CT is also normal. After therapy and short clinical observation he feels better,…

ByIlenia Spallino11 July 20130Comments

Abdomen

Imaging strategies of suspected acute colonic diverticulitis: how does it work?

A 66 yo man complains of left lower quadrant (LLQ) pain, anoressia and fever, it is the first time. The pain is acute, there is not vomit, temperature is 38°C. Abdomen is treatable, with severe pain and tenderness localized at LLQ , there is not history of prior abdominal surgery. Probably this patient suffers of…

ByCiro Paolillo10 April 20130Comments

Bones and joints

Is it broken?

A nthony, a 15 y/o student, slipped and fell while playng soccer. The next morning he refers continue pain on the right elbow. “Is it broken?” ask Anthony and his father at the triage desktop? There is pain and edema near the elbow, no radial pulse deficit, he can fully extend and flex the articulation,…

ByCiro Paolillo7 January 20130Comments

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

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

The Emergency Physician

Ottawa ankle rules. Does it really work?

Plain X ray in suspected bowel obstruction. Is that all?

Headache and Subarachnoid haemorrage. How and how long your pain started?

Imaging strategies of suspected acute colonic diverticulitis: how does it work?

Is it broken?

Pleuritic pain and radio-occult lesion

Can Ultrasound rule out a pneumothorax?

Thoracic trauma and chest X-Ray

Chest X-Ray and aortic dissection

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

Septic Arthritis

Septic Arthritis and Arthrocentesis

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