Practice Management
A 27-year-old female with history of asthma presents to urgent care on a Friday morning with dyspnea for 1 day. She denies palpitations, syncope, or chest pain. An ECG is obtained. View the ECG captured above and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
Read More
Hematoma Blocks Effective for Closed Forearm Reduction Take Home Point: Hematoma blocks are an effective method of achieving analgesia to facilitate closed reduction of forearm fractures. Citation: Pitman G, Soeyland T, Popovic G, et al. Hematoma block is the most efficient technique for closed forearm fracture reduction: a retrospective cohort study. Emerg Med J. 2024; 41:595–601 Relevance: Adequate closed reduction of wrist and forearm fractures acutely after injury is important to reduce risk of complications …
Read More
A 16-year-old girl presents to urgent care with complaints of fever, chills, and a diffuse sunburn-like rash that developed over the past day. The patient underwent septoplasty 2 days prior for a deviated septum, and nasal packing was utilized to manage her postoperative bleeding. On examination in urgent care, she was febrile to 104°F (40°C), tachycardic, and hypotensive. Widespread erythematous blanching macules and patches were seen. View the image below and consider what your …
Read More
In a prior editorial, I described the case of Thomas, a young man among the “worried-well,” who presented to urgent care (UC) with anxiety related to an alarm that sounded as a result of a malfunction of a continuous glucose monitor (CGM), which was prescribed despite his lack of a diagnosis of diabetes, out of concern for abnormal blood glucose levels.[1] The underlying issue prompting his visit was not hypoglycemia but what I refer to …
Read More
Urgent Message: Diverticulitis is a prevalent condition characterized by localized inflammation most commonly of the sigmoid colon. It is often diagnosed with a computed tomography scan with intravenous contrast. Uncomplicated cases are most common and require only monitoring, however complicated cases can require hospitalization and emergent surgical intervention. Urgent care clinicians should be comfortable assessing patients with possible diverticulitis and recognizing features that suggest the possibility of more complicated disease. Naushair Hussain DO; Shahmeer Hussain …
Read More
Shomel Gauznabi, MBChB, FRNZCGP, FRACGP, FRNZCUC, MD; Ivan Koay, MBChB, MRCS, FRNZCUC, MD Urgent Message: There is literature supporting that regional anesthesia, specifically hematoma blocks, is a safe, effective, and well tolerated alternative to procedural sedation for the management of pediatric forearm fractures. Citation: Gauznabi S, Koay I. Systematic Rapid Review: Efficacy of Hematoma Blocks for Pediatric Forearm Fractures. J Urgent Care Med. 2024; 19(x):42-50 Key Words: pediatric forearm fractures, anesthesia, hematoma blocks, urgent care …
Read More
ECG Interpretation: Humans Vs Machines Take Home Point: In this study, cardiologists and emergency physicians (EP) had greater accuracy for electrocardiogram (ECG) interpretation than current versions of ChatGPT and Gemini. Citation: Günay S, Öztürk A, Yiğit Y. The accuracy of Gemini, GPT-4, and GPT-4o in ECG analysis: A comparison with cardiologists and emergency medicine specialists. Am J Emerg Med. 2024 Oct:84:68-73. doi: 10.1016/j.ajem.2024.07.043. Relevance: Artificial Intelligence (AI) is rapidly evolving and becoming an integral part …
Read More
“Low blood sugar” was his chief complaint, but Thomas was in my urgent care (UC) mostly because he was feeling anxious. It wasn’t hypoglycemia that was making him nervous either. Thomas didn’t have diabetes or take any medication for high blood sugar. Regardless, he was wearing a continuous glucose monitor (CGM), which he lifted his shirt to show me when I entered the room. Thomas explained his primary care physician (PCP) had prescribed the device …
Read More
Urgent Message: Fractures of the midshaft ulna, commonly referred to as “nightstick fractures,” typically occur after direct injury to a forearm outstretched above the head as a protective mechanism. Evaluation includes inquiry into the circumstances of the assault, assessment for any other areas of trauma, examination of the skin, wrist and elbow joints, and radiography of the forearm. Management of closed, nondisplaced midshaft ulnar fractures centers around splint immobilization and arrangement of appropriate follow-up. Chandrika …
Read More
A 55-year-old woman presents to urgent care complaining of pain when she moves her right wrist. She reports the pain began suddenly when she woke up that morning without any known trauma. An x-ray is ordered. Review the image and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page.
Read More