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Likelihood Ratio (LR) in Emergency Medicine


Headache and Subarachnoid haemorrage.
 How and how long your pain started?

Clinical Scenario

A young healthy man presents to the ED because of acute onset severe headheache. The pain has started the day before while he was swimming, he refers the worst headache of his life, neurological examination and vital signs are all normal. Head CT is also normal. After therapy and short clinical observation he feels better, but the pain continues, even if less, neurological examination is still normal.

May this patient has a subarachnoid haemorrage (SAH)?



Sciatica: only pain control, or imaging? Point your big toe to your nose!!!

Clinical Scenario

A 50 y/o friend of yours called for you. He refers low back pain radiating to his left leg from approximately 2 weeks. “help me doc - he says -  I have a sciatica, a dog is biting my buttock, can you favor me with an urgent RMN?”. He is very suffering. During the straight leg raise test (SLR) he develops pain down the left leg to 30-40 degree. The crossed straight leg raise test (CSLR) is negative. There are no changes in bowel or bladder habits. 

“Point your big toe to your nose” - you ask putting the hand on the your friend’s feet .