Page 2 – A life at risk

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

Bones and joints

Does every shoulder pain means magnetic risonance?

A 35 y/o male come to the ED because of pain in his right shoulder, he refers the pain started some month ago during a tennis match, the pain continued but it wasn't so high so he kept playing in the last months, now it is worse. "My tennis mate told me I should perform…

ByIlenia Spallino9 February 20140Comments

Abdomen

Alarm symptoms and gastric cancer. Are they alarms or they are alarming?

It’s a busy Monday morning in ED. A doctor at the phone – calls the nurse – there’s a primary care physician. Hi – says a voice on the other side – I’m in a patient’s home. He’s a 40 yo man with dyspepsia, his wife refers weight loss of about 10…

ByCiro Paolillo24 January 20140Comments

Abdomen

Age of 45 and dyspepsia

It’s the begining of another night shift in ED. Rik, an agreable young colleague approximates: Hi- he says – I have just seen a 60 y/o man who refers epigastric pain since 2 days. He denies bleeding and weight loss, he isn’t anemic. The bedside US shows a normal gallbladder and a normal abdominal aorta,…

ByIlenia Spallino11 January 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

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

Featured Uncategorized

Sick or not-sick at a glance. Is it reliable?

It’s a busy Monday morning in ED, many ambulance are on the go. There’s been a car crash on the high street - says the nurse – we must free the rooms immediately. There is a full flow now. In a box there is a young man, the doctor observes the patient form the outside,…

ByCiro Paolillo11 October 20130Comments

Bones and joints

Low probability of mandibular fracture? C’mon grit your teeth!

It’s a Saturday busy night, in ED when a 31 yo male comes referring pain in the chin and next to the right ear after a trauma. He was out celebrating his birthday, slipped and fell on to his chin. Vital signs are normal, there aren’t wounds, he denies malocclusion, the palpation of the…

ByCiro Paolillo15 September 20130Comments

Abdomen

Is it a subtle appendicitis? How to make time your friend (part two)

It’s about the end of the night shift, in Observation Unit there’s George a 25 yo male presented the evening before with a mild periumbilical pain since 2 days than localized to the right lower quadrant. He was afebrile with stable vital signs, in the car, arriving to the ED, there was vomit, not diahrrea.…

ByCiro Paolillo11 September 20130Comments

The Emergency Physician

Ottawa ankle rules. Does it really work?

Does every shoulder pain means magnetic risonance?

Alarm symptoms and gastric cancer. Are they alarms or they are alarming?

Age of 45 and dyspepsia

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

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

Sick or not-sick at a glance. Is it reliable?

Low probability of mandibular fracture? C’mon grit your teeth!

Is it a subtle appendicitis? How to make time your friend (part two)

Septic Arthritis

Septic Arthritis and Arthrocentesis

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