Page 5 – A life at risk

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

Abdomen

Does procalcitonin have a role in the management of acute appendicitis?

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…

ByCiro Paolillo10 October 20120Comments

Bones and joints

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

A 40 yo lady arrives in ED by ambulance with neck and spinal immobilization because she fell down a staircare. The patient’s vital signs are within normal physiological parameters, she is 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…

ByCiro Paolillo7 September 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

Abdomen

Goodbye nasogastric lavage!

A 84 yo woman arrives in ED in midnight coming from a nursing because of a reported episode of coffee ground vomiting. Respiratory rate, heart rate and blood pressure are normal, abdomen is not distended, hemoglobin level is 10 g/dl. On rectal examination you find normal stool. She takes warfarin. Can a nasogasric…

ByCiro Paolillo10 July 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

The Emergency Physician

What does it hide behind a negative X-Ray?

Pleuritic pain and radio-occult lesion

Does procalcitonin have a role in the management of acute appendicitis?

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

Cellulitis and the role of laboratory

Goodbye nasogastric lavage!

Can Ultrasound rule out a pneumothorax?

Thoracic trauma and chest X-Ray

Chest X-Ray and aortic dissection

Septic Arthritis

Septic Arthritis and Arthrocentesis

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