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Likelihood Ratio (LR) in Emergency Medicine


Is CRP useful alone to support the hypotesis of a bacteremia?

Clinical Scenario

It’s a very cold February, but ED is very hot in every sense of the word. 
A 22 y/o student refers stomach pain, chills, fever and diffuse muscolar pain. He has fever (38° C) there is a mild diffuse abdominal pain. 
The CRP value is 30 mg/L. 
Are there flu symptoms, or it is a bacteremia?

Can we use the CRP test for change our clinical suspicion? 



Malaria or just fever?

Clinical Scenario

A 35 y/o man is brought to the ED by friends and left there alone, he has high fever, he is from Ghana and he has just arrived, he speaks english not so well and he is confused and agitated, so anamnesis is very difficult and you catch a only word “malaria”, you also know that africans often calls malaria every fever, but …
Clinical examination is normal except for the agitation state, but fever is very high (40,5°C), he has not headhache, no cough, no abdominal pain. It is night and microbiologist is not available for malaria microscopy test and you decide to perform, for the first time in your life, the rapid test…it is negative…

Can you trust it or the patient?



Is chest X ray necessary to rule out PNX after thoracic maneuvers?

Clinical Scenario

It’s a busy day in ED this morning. 
The first patient refers dyspnoea, he has an advanced pulmonary neoplasia, ultrasound and chest x-ray confirm that the left zone is occupated by a pleural effusion. The thoracentesis removes about 1.5 liter of fluid, the patient breathes easily.

The second patient is 65 yo, he has pneumonia, he is septic, it’s impossible to find a vein, the right internal jugular vein is identified by ultrasound and the catheterization is performed without any problem.   

Is it necessary in this cases to perform a chest  X-ray to rule out a PNX?