Lee A. Resnick, MD, FAAFP It’s springtime again, and for us Northerners, that is a welcome sign. It’s time to end months of hibernation holed up in our overly heated homes. It’s time to break out of our winter routine of work, eat, and sleep and welcome in several months of energizing warmth and rejuvenated spirit. At UCA, we use this time of year to re-energize the membership, welcome in new members, and set the …
Read MoreClinical Challenge 2: February 2008
The patient is a 3 ½-year-old girl who fell from a bicycle, receiving a blow to the elbow a short time before presentation. She had marked swelling and local tenderness over the elbow. The only other remarkable finding was a pulse of 132. View the x-ray taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
Read MoreAbstracts In Urgent Care: February, 2008
Over the Counter but No Longer Under the Radar—Pediatric Cough and Cold Medications Key point: Since 1985, all six controlled studies of cough/cold preparations in children have not shown a positive effect. Over the last 7 years, poison-control centers have reported more than 750,000 calls Citation: Sharfstein JM, North M, Serwint JR. N Engl J Med. 2007;357(23):2321-2324. In recent weeks, over-the-counter cough and cold medications for children have received unprecedented attention from reg- ulators, physicians, …
Read MoreClinical Challenge: February, 2008
The patient is a 9-year-old girl who fell and received a blow to her right chest. A few hours later, she presented to urgent care complaining of pain on deep breathing. On exam, you find a pulse of 103, and SAT of 96. She is not in respiratory distress; her chest exam was clear and she has an abrasion over her right chest. She is generally healthy, is on no medica- tions, and has no …
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Integration of Pharmacologic and Non-pharmacologic Techniques to Enhance Pediatric Minor Procedures
Urgent message: Integration of various techniques when performing minor procedures on children can enhance clinical care for patients and families while bringing within reach administrative and financial goals. Emory Petrack, MD, FAAP, FACEP, Lisa S. Perry, CCLS, and Kristine Vehar, RN As the practice of urgent care medicine continues to grow, urgent care centers grapple with several important issues, among them the needs to provide optimal clinical care, reduce medical legal risk, and deliver excellence …
Read MoreA Field Guide to Evaluating Medical Literature
Lee A. Resnick, MD, FAAFP Urgent care medicine is a rapidly evolving discipline. Out of this evolutionary process, scientific skepticism is naturally born. It is the checks and balances of medicine, ensuring that what is purported to be true, is in fact based on evidence, not speculation. We welcome this inquiry and support the process necessary to lend legitimacy to what has been mere estimation and speculation, thus far, in the development of our discipline. …
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A 4-Year-Old Who Fell from the Slide
Urgent message: Injuries sustained in playground falls are common presentations to emergency departments and urgent care centers alike. The urgent care physician should be alert to the keys to evaluation and management of traumatic neck pain. Muhammad Waseem, MD, Lalithambal Venugopalan, MD, and Gerard Devas, MD Cervical spine (C-spine) injuries occur infrequently in children. This is especially true for fractures of atlas vertebra, which is a rare injury in children. Its diagnosis may easily be …
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The Case of a 17-Year-Old Male with Fever and Headache
This month, we will discuss Question III: What is the incidence of deaths in patients recently discharged from the ED? In May 2007, Sklar et al performed a very interesting study concerning deaths that occurred within seven days of ED discharge. A similar study had been done in 1994 by Kefer et al, looking at medical examiner cases. Sklar’s study, however, is more likely to have captured all unanticipated deaths because it was performed at …
Read MoreAbstracts In Urgent Care: January, 2008
NEJM Article Blames CT-Related Radiation for Up to 2% of Cancers in U.S. Key point: The growth of medical CT utilization may be re- sponsible for 1.5% to 2% of cancer cases in the U.S. Citation: Brenner DJ, Hall EJ. N Engl J Med. 2007;357:2277- 2284. A New England Journal of Medicine review article published recently targets the cancer risks of CT at the same time that hundreds of scientific presentations and new products at …
Read MoreClinical Challenge: January, 2008
The patient is a 26-year-old male who slipped and twisted his left ankle. He is unable to bear weight on the ankle and there is marked local swelling circumferentially around the ankle. Oth erwise, he is generally healthy. View the x-ray taken (Figure 1) and consider what your diag- nosis and next steps would be. Resolution of the case is described on the next page.
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