Journal of Urgent Care Medicine

The Road to Recognition

Lee A. Resnick, MD, FAAFP The recent announcement that the American Board of Medical Specialties approved Hospice and Palliative Care as a new subspecialty appears to ring in a new era of subspecialty acceptance. It was once thought that subspecialties found their homes with one sponsor; Cardiology, Gastroenterology, and Pulmonology were all within the realm of Internal Medicine. Pediatrics followed suit with its own versions of these subspecialties. There was no con-joint sponsorship from multiple …

Management of Erythema Multiforme in the Urgent Care Setting

Urgent message: With the increasing use of medications, especially antibiotics, more and more patients are presenting to urgent care with erythema multiforme. Correct diagnosis and identification of the underlying cause can result in rapid clinical resolution of the lesions. Shailendra Kapoor, MD Descriptions of erythema multiforme (EM) first appeared in the work of Albert and Bazin in 1822, but it was not until 1866 that von Hebra categorized these erythematous eruptions and labeled them “erythema …

Abstracts In Urgent Care: May, 2007

Are Cardiac Risk Factors of Value in ED Diagnosis of ACS? Citation: Zane RD. J Watch Emerg Med. March 9, 2007. URL: http://emergency-medicine.jwatch.org/cgi/content/ full/2007/309/3?q=etoc The Role of Cardiac Risk Factor Burden in Diagnosing Acute Coronary Syndromes in the Emergency Department Setting Citation: Han JH, Lindsell CJ, Storrow AB, et al. Ann Emerg Med. 2007;(2):145-152. Epub Dec 4, 2006. URL: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve& db=pubmed&list_uids=17145112&dopt=Abstract Key point: Cardiac risk factors are of no discriminatory value in emergent evaluation …

Clinical Challenge: May, 2007

The patient is a 2½-year-old female who presented after falling, unobserved, from an unknown height with tenderness and swelling around the elbow. Neurovascular exam was normal. 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. Resulotion The correct diagnosis is a supracondylar fracture; note the loss of the normal angle at the distal humerus. The injury was managed …

Clinical Challenge 2: April, 2007

The patient is a 25-year-old male who presented to urgent care after falling from a height of two stories, landing flat on his feet. He is able to ambulate, though only with pain. In addition, he complains of back pain. He is generally healthy, and no neurological deficit was found. View the x-ray taken (Figure 1) and consider what your next steps would be. Resolution of the case is described on the next page.

Abstracts in Urgent Care: April, 2007

Computed Tomography Coronary Angiography for Rapid Disposition of Low- risk Emergency Department Patients with Chest Pain Syndromes Citation: Hollander JE, Litt HI, Chase M, et al. Acad Emerg Med. 2007;14(2):112-116. URL: http://www.aemj.org/cgi/content/abstract/14/2/112 Key point: CT coronary angiography may safely allow rapid dis- charge of patients with negative studies. Patients with recent normal cardiac catheterization are at low risk for complications of ischemic chest pain. Computed tomography coronary angiography has high correlation with cardiac catheterization for …

A 55-Year-Old Woman with Abdominal Pain

Urgent message: Noting ‘red flags’ specific to the individual patient is of key importance when details of the presentation do not add up. Jill Chavinson Miller, MD J.W. is a 55-year-old female non-smoker who presented with abdominal pain. She reported that the pain woke her up the night before and lasted all day long, which prevented her from doing much that day. She described the pain as constant and gnawing, assessing its severity as 6 …

A 45-Year-Old Man with Cough and Sore Throat: A Two-Step Approach to Avoiding a Bounceback

Urgent message: The clinician must address unexpected findings with further questions or testing. Michael B. Weinstock, MD and Ryan Longstreth, MD, FACEP This is the first article in a series that will appear every other month in JUCM, in which we will recount scenarios of actual patients who presented to an emergency department or urgent care facility, were evaluated and discharged, and then “bounced back.” Each of these cases is detailed in the book Bouncebacks! …

An Approach to Care of Injured Workers

Urgent message: Appropriate treatment of workplace injuries and illnesses minimizes long-term disability while promoting rapid return to work and safer work environments. David M. Rosenberg, MD, MPH Physicians rendering care to injured workers must be knowledgeable regarding these injuries and the necessary types of treatment. Also, they must provide this care in an empathetic and caring manner, coupled with aggressive intervention to promote prompt healing. However, physicians must also realize that early return to work …

The Dizzy Patient in the Urgent Care Setting

Urgent message: “Dizziness” can prove to be one of the more vexing complaints encountered in urgent care. To provide appropriate care, the clinician must understand whether the patient is experiencing near-syncope, disequilibrium, ill-defined light-headedness, or vertigo. Martin Samuels, MD, DSc (hon), FAAN, MACP The problem of dizziness can be one of the most exasperating in the practice of medicine. Physicians all know that sinking feeling elicited by the patient who sits down and, when one …