Journal of Urgent Care Medicine

Evaluation, Identification, and Treatment of Urinary Tract Infections

Urgent message: Urinary tract infections are a common cause of abdominal pain and a common presenting complaint in urgent care. Proper diagnosis, treatment, and patient education on preventive measures are key to optimal outcomes. William Gluckman, DO, MBA, FACEP, Karen Keaney Gluckman, MSN, APN, C, CWCN, CCCN The global term urinary tract infection (UTI) incorporates cystitis and infection involving the bladder (a lower tract source), as well as pyelonephritis, an infection involving the kidneys (an …

What About Retail Health?

There is plenty of posturing going on within organized medicine with regard to the “retail health” revolution. Concerns have been raised regarding continuity of care, the “corporatization” of medicine, kickbacks to pharmacies, and the quality of care provided by nurse practitioners and physician assistants. American Academy of Family Physicians, the American Medical Association, and the American Academy of Pediatrics have all chimed in. Only the AAP has come out consistently opposed to the idea on …

Abstracts In Urgent Care: September, 2007

Evaluating Fever of Unidentifiable Source in Young Children Key point: An excellent review of the approach to the febrile child. Citation: Sur DK, Bukont EL. Am Fam Physician. 2007;75:1805- 1811. Even with a thorough history and a complete physical examination, one in five acutely ill, nontoxic-appearing children had an unidentifiable source of fever. Physicians should be cautious in their approach because of the potential for unrecognized and untreated serious bacterial infections (SBI). The review notes …

Clinical Challenge: September, 2007

The patient is a 10-monthold child who presents, with the parents upon referral by the pediatrician, with a history of three days of pain, but no history of trauma. The child refuses to stand, presumably due to pain, and resists crawling. 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.

The Case of a 33-Year-Old Male with Abdominal Pain

Over the next few installments of this series, we will be discussing “bounceback” studies, and answering the following questions, in sequence: What is the incidence of bouncebacks? What is the incidence of bounceback admissions? What is the incidence of deaths in patients recently discharged from the ED? What percent of bouncebacks occur because of medical errors? How can we use this information to improve patient safety? Our feeling is that if we can use these …

Managing Heat Illness in Urgent Care

Urgent message: The urgent care provider’s most critical role in heat illness is to identify risk factors and the cause, to cool and hydrate the patient, assess for complications, and educate the patient in the hope of preventing a more serious exposure. Bridget Dyer, MD, Samuel Keim, MD, and Peter Rosen, MD Heat illness occurs when external heat conditions and internal heat production overwhelm the ability of the body to dissipate heat. Evaporation of sweat …

Lessons Learned

Lee A. Resnick, MD, FAAFP Between sticky ribs and spicy BBQ sauce, I mingled with the future generation of doctors at the annual AAFP Residents and Students Conference in Kansas City. I was reminded of several very important things… I am old I didn’t just finish my residency I need to get a “MySpace” account and learn how to “IM.” In addition to my mini-mid-life crisis, my booth was dead. I was sure there would …

Clinical Challenge: August, 2007

The patient is a 9-year-old boy who received a blow to the shoulder from a height of approximately 6 ½ feet. He has limited elevation of the arm due to pain. 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. <

Clinical Challenge 2: July 2007

The patient is an 18-year-old male who jumped or fell from a “short height” but landed hard on his heel. He is able to ambulate, but cannot put any pressure on his heel. 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.

Management of Distal Radial Fractures in Young Patients by Non-Orthopedists in an Urgent Care Center

Wrist fracture is a common injury in children. 1 Many of these fractures are buckle or torus fractures. Traditionally, treatment for buckle fractures has been short-arm casting for two to four weeks.2 However, questions have been raised as to the need for such treatment. A number of recent studies have indicated that many such fractures may be managed without casting by the use of either elastic bandaging alone3 or splints.4-6 Plaster splints can easily be …