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Likelihood Ratio (LR) in Emergency Medicine


How have you come to the hospital?

Clinical Scenario

It’s just started your night shift, Sara is a young EP, she is going home after an hard day.  Hello - she says tired - could you help me? There is a guy with abdominal pain and nausea. I think it could be appendicitis, but there is not fever and not leukocytosis. 

Have you asked if he arrived by car? - You say
No, why? 



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

Clinical scenario

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 an acute colonic diverticulitis (ACD).

Is Computer Thomography (CT) the imaging procedure of choice for this patient? 



To fill or not to fill? Try to raise the legs...

Clinical Scenario

A 54 y/o man is brought to the ED because his wife has found him semiunconscious in the morning, he has  not significant clincal history and does not take medicaments, he presents hypoperfused, arterial pressure is 90/50 and MAP is 63, lactate is 7 mmol/L and hemoglobin is 14 g/dl. Inferior vena cava diameter is 1,5 cm. Respiratory variation of inferior vena cava is about 25%
Yours is a diagnosis of shock, your dilemma is if he will respond or instead be harmed by fluid administration, you a have a 50% possibility, you can flip a coin or maybe raise the patient’s legs….