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Likelihood Ratio (LR) in Emergency Medicine

8/24/2013

Is it a subtle appendicitis? How to make time your friend


Clinical Scenario

Mr. Smith is a 39 yo man with abdominal pain. He has been visited, few hours ago, by his primary care doctor who sent him to you for a surgeon consult. He refers abdominal pain, fever and nausea since the day before. The pain was previously in the midabdomen, than it migrated to the right lower quadrant (RLQ). 
Temperature is 38°C, he is tachicardic, he has a moderate pain in RLQ, there aren’t signs of peritonitis.  Appendix  Is not visualized at US examination.  
Laboratory evaluation reveals WBC count 12.000 (cells/microL)  and CPR 7 (mg/L) . 
Patient’s presentation is suggestive for appendicitis but not clearly diagnostic. Let’s see what the surgeon advices.
“He is not yet ready for the operating room” he says “it’s better to repeat a laboratory evaluation, please call me in four hours”. 
The patient is admitted to observation unit. 
How will the change of laboratory tests help you after four hours?  


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8/03/2013

Do you suspect a lower UTI? Urine analysis sometimes is over!


Clinical Scenario

A 30 yo woman comes in ED complaining a burning pain when urinating, hematuria  and increased of urinary frequency.  She denies abdominal pain, fever, and vaginal discharge, she is not pregnant. 
On the right there’s the toilette – the nurse indicates – could you pee in this cup?
Give me antibiotics – she says – it’s a cystitis, I know it, I have to return early at work!



Are history and physical examination sufficient to prescribe antibiotics?

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