Do not request a Duplex scan of the carotid arteries for vertigo, tinnitus, headache, neck pain, unless there are neurologic signs.
Symptoms of cerebrovascular insufficiency are often confused with those of other diseases. Furthermore, the term Transient Ischemic Attack (TIA) is often used inappropriately. It should be reserved only for a sudden, focal neurologic attack lasting less than 24 hours,...
Do not request a Duplex scan as a first level test for lower limb arterial disease, in patients that are asymptomatic or with mild claudication. Measure instead the Ankle Brachial Index (ABI).
Duplex scan is often requested for paresthesias with palpable distal pulses. ABI measurement is adequate to diagnose arterial disease and start treatment. If the symptoms are severe the patient can be sent to the vascular surgeon. Following this recommendation would...
Do not perform Duplex scan or Chest CT scan as first level tests for patients that, according to Wells or Geneva score, have a low probability of Deep Venous Thrombosis (DVT). D-dimer determination has a high sensitivity as a first level test.
DVT and Pulmonary Embolism (PE) are very rare in the absence of elevated D dimer levels or specific risk factors. DVT of the lower limbs is a common disease and it is usually suspected in the presence of swelling. Swelling may be due to orthopedic, cardiac or...
Do not perform computed tomography (CT) or nuclear magnetic resonance imaging (MRI) of the brain to patients who have experienced transient loss of consciousness in the absence of other neurological symptoms and have normal neurological examination. Adapted from the American College of Physicians
In patients who have experienced a witnessed loss of consciousness, without the suspicion of seizure and in the absence of other neurological signs or symptoms, the probability that central nervous system damage is the cause is very low and imaging of the brain does...The campaign DOING MORE DOES NOT MEAN DOING BETTER – CHOOSING WISELY ITALY is promoted by Italy’s Slow Medicine
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