Practice Management
An 87-year-old male with past medical history of valvular atrial fibrillation, prior stroke, and heart failure presents to urgent care with chest pain and shortness of breath for 3 days. The pain and difficulty breathing are associated with bilateral lower extremity swelling for 1 week. View the ECG taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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Colchicine in Acute Gout POCUS and Necrotizing Fasciitis Assessing Patient Satisfaction Misinterpreting Pediatric Radiographs Lung Ultrasound and Pediatric Pneumonia Diagnosing Pneumothorax A Review of the Evidence for Colchicine in Acute Gout Take-home point: Colchicine appears to be no more effective than NSAIDs for acute gout flares and evidence does not indicate greater efficacy at higher doses. Citation: Gottlieb M, Rabah W, Long B. Colchicine for acute gout. Acad Emerg Med. 2022;29(3):387-388. Epub ahead of print …
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A 43-year-old woman presents with 2 weeks of a smooth nodule on her right hand. The patient denies recent travel but recalls that she “banged up” her hand while cleaning out a fresh-water fish tank prior to noticing the nodule. Past medical history is significant for renal transplantation. Exam reveals a tender, erythematous plaque with an ulcer on dorsal aspect of her hand. View the image and consider what your diagnosis and next steps …
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The patient is a 12-year-old boy who presents with pain in his left knee. His mother reports that during a baseball game earlier in the day he slid hard into a base and came up limping. Review the x-rays taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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I got my first guitar when I was 14. It was an Alvarez acoustic with an electric pick-up, and I played it every day—at least for a while. I thought it would make me cool and make the girls take notice. But after about a year, when neither of those things had happened, I just about gave up the guitar for good. There simply wasn’t much joy in always playing alone. What revived and has …
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Urgent message: Referrals to the ED for CT scans were reduced when urgent care providers combined clinical judgement with EEG-based structural injury biomarker results. Such reductions could relieve the burden of referrals to EDs, minimize unnecessary radiation risk, yield better patient experience, and foster to potential cost savings. Tanvir Dara MD, FACEP; Elizabeth McCarty MD; Paul Meredith MD; Robert Mooney MD; David Porzio MD; and Alvaro Zeballos MD Citation: Dara T, McCarty E, Meredith P, …
Read MoreMaximizing the Value of Urine Dipstick Testing Screening for Intimate Partner Violence Antibiotics for Children with RTI Azithromycin in Pediatric Viral Infection Self-Monitoring BP with Unvalidated Devices Modified Valsalva Maneuver in SVT To Mix or Not to Mix COVID-19 Vaccines? Ivan Koay, MBChB, FRNZCUC, MD Nitrofurantoin Resistance Take-home point: Proteeae group bacteria, which are often resistant to nitrofurantoin, normally result in alkaline (ie, high pH) urine on dipstick testing. Citation: Sheele J, Libertin C, Fink …
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Urgent message: Appreciation for the cause of knee pain, along with an understanding of potential nonoperative rehabilitation therapies that could be provided in urgent care, can enhance patient care and improve patient satisfaction while minimizing the need for referral. Dr. Eva Delgado Martinez MBChB, GP, MScCN and Dr. Ivan Koay MBChB, FRNZCUC, MD INTRODUCTION Knee injuries in adults and children are common presentations to urgent care and emergency rooms.1 Rehabilitation of those injuries is essential …
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Urgent message: Ultrasound can provide essential data in the urgent care evaluation of abdominal pain, aiding in the diagnosis of intestinal abnormalities, urinary tract infection, and obstetrical and gynecological problems such as suspected ovarian torsion. Andrew Alaya, MD, MSc Introduction Abdominal pain is one of the most common complaints among women of childbearing age who visit urgent centers. Urinary tract infection, diarrhea, constipation, acute viral gastroenteritis (AGE), pelvic inflammatory disease (PID), and dysmenorrhea are the …
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Urgent message: Though the most common fracture seen in pediatric trauma patients, elbow fractures can be difficult to identify in younger patients. Familiarity with elbow anatomy, ossification centers, and fracture patterns is essential for optimal outcomes. Amy Grover, MD CASE VIGNETTE A 7-year-old previously healthy female presents to urgent care with a chief complaint of left elbow pain after a fall on outstretched arm. She had immediate pain, swelling and difficulty moving her arm. Her …
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