NAHUM KOVALSKI, BSc, MDCM Effect of Adrenaline on Survival in Out-of-hospital Cardiac Arrest Key point: Adrenaline improves chance of return of spontaneous circulation but not survival to discharge. Citation: Jacobs IG, Finn JC, Jelinek GA, et al. Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomized double-blind placebo-controlled trial. Resuscitation. 2011;82(9):1138-1143. Adrenaline has been used to treat patients with cardiac arrest for more than half a century but has not been evaluated in …
Read MorePotential Pitfalls While Finding the Needle in the Haystack
JOHN SHUFELDT, MD, JD, MBA, FACEP It’s nearly midnight on Saturday and I am between patients in an ED on an unseasonably cold November evening in Phoenix, Arizona. Among the head bleeds, overdoses, MI’s, and strokes, I have had these chief complaints thrown at me: “Smoke inhalation after blowing out a candle” “I can’t stop playing with my number one.” “I’m here for my 40-year-old physical.” (The patient was 43.) “I fell asleep at a …
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An Urgent Care Lab as a Profit Center?
Urgent message: An onsite lab can generate significant revenue for your practice. Lab expert Tim Dumas shows how. TIM DUMAS, MLT,CLS Introduction I have been a lab tech for almost 35 years and serve as advisor to 45 physician office labs around the country. I have seen many changes in that time, most for the better. Thirty—even 20—years ago, a stat CBC with differential was a 15-minute-procedure and required a skilled lab tech to get …
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A Painful Swollen Joint in an Elderly Male
Urgent message: The patient had two recent bee stings. Did they cause his problem or were they red herrings? PAUL BURES, DO, and LEE A. RESNICK, MD Introduction Hot, swollen, tender joints are a common initial complaint in the urgent care setting. Depending on the patient’s HPI and PMH, a definitive diagnosis can often be concluded. A systematic evaluation of infectious, inflammatory, and traumatic causes can help narrow the differential. Judicious use of the laboratory …
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Altered Mental Status in the Urgent Care Patient
Urgent message: As the population of seniors swells, more cases of senile dementia, delirium, and psychosis are apt to present in urgent care. Here is how to assess and manage these patients. RAUL E. RODON, MD Introduction Evaluating patients presenting with altered mental status in the urgent care setting requires a modified skill set, one that varies from the assessment of patients with a similar profile in a hospital emergency department. Limited access to standard …
Read MoreReforming Healthcare Starts With Reforming Patient Expectations
Back in 2008, while the Obama administration was first evaluating healthcare reform, Peter Orszag, then the director of the Congressional Budget Office, estimated that 5% of the nation’s gross domestic product, or $700 billion per year, goes to medical tests and procedures that have no proven positive impact on outcomes. Unaccounted for in this estimate are the billions more spent managing the often lifelong complications inherited from inappropriate tests and unproven procedures. MRIs that identify …
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75-year-old experiencing dysphagia after swallowing bone
The patient, an otherwise-healthy 75-year-old, was eating fish, felt a swallowed bone, and has experienced progressive dysphagia since. View the image taken and consider what your diagnosis and next steps would be
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2-1/2 year-old with recurrent abdominal pain
The patient, an otherwise healthy 2-1/2 year-old, experienced recurrent episodes of abdominal pain without vomiting or diarrhea. On exam, fullness of the abdomen was present. View the image taken and consider what your diagnosis and next steps would be. Click on the button below to see the resolution of the case.
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27-year-old presents a jammed right finger
This otherwise healthy 27-year-old jammed his right finger today. NL distal perfusion. Palpable reduction achieved with traction. Continued instability. Subluxates with flexion. Therefore, placed in splint to return for ortho tonight. View the image taken and consider what your diagnosis and next steps would be. Click on the button below to see the resolution of the case.
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