Clinical Scenario 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…
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Clinical Scenario Anthony, 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…
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Clinical Scenarios It 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…
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Clinical Scenario   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…
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Clinical Scenario 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,…
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Clinical Scenario   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…
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Clinical Scenario   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,…
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Clinical scenario A 18 yo man comes to the ED in the morning because of low abdominal pain,fever and nausea. At palpation there is mild pain in the right inferior quadrant,not guarding. Could procalcitonin (PTC) helps to exclude quickly an acute appendicitis?     Conclusion The figures are clear. We cannot use the PCT to rule out an acute appendicitis, but it could be useful  to identifypatients that may have complicated appendicitis. In previous post we have pointed out the poor utility of signs and symptoms alone to screen patients with or withoutan acute appendicitis.…
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Clinical Scenario A 40 yo lady arrives in ED by ambulance with neck and spinalimmobilization because she fell down a stair care. The patient’s vital signs are within normal physiological parameters, sheis alert, no deficit, remembers all, denies head contusion and neck pain.She complains for a sharp shoulder pain (NRS 10/10), it seems broken. If I perform the Nexus C-Spine criteria  X Ray is indicated: a distractinginjury mandates cervical spine imaging. How much the presence of distracting injury reduces my sensibility in rule out cervical spine (c-spine) injury?   Conclusion   Once upon a time nearly all patients who presented in ED with blunt trauma received a cervical spine X-Ray. Theclinicians feared to undiagnosed a cervical fracture, with catastrophic consequences for the patients and than for thesame doctor, so there were a large number of unnecessary films. The Nexus five criteria simplified our work: it’s easy and speedy and especially is high sensitive to rule out a cervical spine injury. The presence of a distracting injury has anegligible impact. Is it time to define the Nexus four criteria?…
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Clinical Scenario  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…
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