Pulmonary embolism / Tromboembolismo pulmonar

Think about it whenever you have a patient who presents with abrupt unexplained shortness of breath, tachypnea and tachycardia, specially in the setting of deep venous thrombosis, recent surgery, having to wear a cast on the leg, prolonged immobilization (like after a long trip), or active cancer. After a careful examination, you may find out…

Community acquired pneumonia / Neumonía adquirida en la comunidad.

Diagnosis will be based on the clinical presentation and the results from a plain chest x-ray. There are very sensitive and specific symptoms and signs that will form a “constellation” most associated with pneumonia. X-ray will then confirm the suspicion. Although, it must be said that older patients my have different signs and symptoms like…

Infective endocarditis diagnostic criteria / Endocarditis infecciosa, criterios diagnósticos.

Criteria can be quickly summarized in: Major clinical criteria (or pathological criteria) – Evidence of either valve damage or evidence of microorganisms within the bloodstream: Positive ecocardiography for infective endocarditis: vegetation, abscess, dehiscence of prosthetic valve. 2 separated positive blood cultures for typical IE microorganisms, or a single one for Cox. Burnetti. Minor clinical criteria…

Acute calculous cholecystitis / Colecistitis aguda calculosa.

Acute cholecystitis (inflammation of the gallbladder) results from injury from a gallstone, like impactation or cystic duct obstruction. Sometimes inflammation occurs without gallstone disease due to infection of bile (acalculous cholecystitis). The main difference between a patient who complains from abdominal pain and suffers from uncomplicated gallstone disease and acute cholecystitis is the evidence of…

Gallstone disease in adults / Cólico biliar en el adulto.

Abdominal pain is very common in the emergency department. Plenty of times patients complain of pain, but the physical examination results completely normal. Because of WHERE it hurts (upper right quadrant), suspicion of gallstone diseases rises. Things get tricky when lab results are normal, and the possibility of a final diagnosis in the ED disappears…

Cardiac tamponade / Taponamiento cardiaco.

A major complication of trauma and pericarditis, and a feared cause of hypotension and obstructive shock, cardiac tamponade occurs when there’s fluid in the pericardial space. This may be from effusion (pericarditis, serositis) or blood, such as in thoracic trauma. As the heart is “imprisoned” within its own pericardium, diastole is restricted, and ultimately systole…

Abdominal pain in the ED / Dolor abdominal en urgencias.

While very common in the emergency department, abdominal pain can be challenging, since the causes range from functional disorders, non severe organic diseases up to bad acute abdomen real life threatening emergencies. Women and elderly patients represent an even more challenging population due to an expanded list of possible diseases and higher frequency of atypical…

“Do not do” and “Do” recomendations in the elderly patient.

From SEMFYC’s “Recomendaciones no hacer y hacer en el anciano” (https://www.semfyc.es/biblioteca/recomendaciones-no-hacer-y-hacer-en-el-anciano/) The following illustration is a summary of some of things we must be aware of when treating and prescribing medication for an elderly patient. Different chronic conditions present, lots of medication and higher risk for adverse effects, much more sensibility and less glomerular filtrate,…