A 62-year-old female presents to the urgent care center with a three-week history of a pruritic facial rash that initiated on one cheek, then spread to the rest of the face. The patient states the rash got worse after sun exposure. Initially, she self-treated with cold cream, Eucerin, and other over-the-counter moisturizers that did not help. Eventually, the patient tried a topical hydrocortisone cream that made the rash much worse. You note there is no …
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82-year-old man injured from falling to his back
The patient is an 82-year-old man who presents after having fallen backwards and landing on his back. He did not lose consciousness; nor did he vomit. The patient enters the clinic using a walker, which he reports using on a regular basis. Examination reveals an abrasion over his forehead and over the anterior right tibia. The neurological exam shows no acute changes. The patient is specifically tender over the shoulder, but there is no spiny …
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15-year-old boy experienced a blow to both ankles
The patient is a 15-year-old boy who experienced a blow to both ankles and the right knee two days ago. You observe that he can bear weight only minimally, with tenderness over the lateral and medial malleolus, as well as over the knee. You also observe there is marked swelling. View the x-ray taken and consider what your diagnosis and next steps would be.
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3-year-old girl falls from bicycle and recieves blow to elbow
The patient is a 3-year-old girl who fell from a bicycle, receiving a blow to the elbow a short time before presentation. You note marked swelling and local tenderness over the elbow. The only other remarkable finding is a pulse of 132. View the x-rays taken and consider what your diagnosis or next steps would be.
Read MoreAbstracts
H1N1 Update: CDC Recommends Seasonal Flu Vaccination for Children Over 6 Months Key point: Get vaccinated! Citation: Fiore AE, Shay DK, Broder K, et al. Prevention and control of seasonal influenza with vaccines. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR. July 24, 2009; 58 (Early Release): 1-52. Available at: www.cdc.gov/mmwr/preview/mmwrhtml/rr58e0724a1.htm. In contrast to last year, when seasonal flu shots for those between 6 months and 18 years of age were “encouraged,” …
Read MoreCommunity-acquired Pneumonia
The patient is a 45-year-old woman (herself a surgeon) who presented three weeks after first visiting her family physician with a cough, at which time the x-ray shown in Figure 1 was taken. She was started on erythromycin for 10 days. After finishing that course of antibiotics with no improvement, she was started on amoxicillin-clavulanic acid. Four days later, there was still no improvement in her status. Second Presentation: Urgent Care By the time the …
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Type 2 diabetic male experiencing painful rash
The patient is a 51-year-old male with uncontrolled type 2 diabetes who presents with a painful, raised, pruritic rash that began after an afternoon of gardening eight days ago. In the interim, he self-treated with over-the-counter topical hydrocortisone 1 percent without relief. View the photo and consider what your diagnosis or next steps would be.
Read MoreGaleazzi Fracture–Dislocation of the Wrist or Isolated Distal Radius Fracture?
Urgent message: Fractures of the distal radius are a common presentation in the urgent care setting. Nonetheless, a high index of suspicion is required for the diagnosis of a Galeazzi fracture–dislocation.By Heather L Hinshelwood, MD and David Caro, MD IntroductionThe anatomic structure of the forearm typically maintains the integrity of the distal radioulnar joint when the radius is fractured. However, in certain situations this joint may be compromised with certain rotational forces. CaseA 14-year-old African-American male …
Read MoreAbstracts in Urgent Care: July/August, 2009
Early Estimate of Pandemic Potential of Influenza A H1N1 “Swine Flu” Key point: The current virus is transmitted efficiently but probably is less lethal than past pandemic viruses. Citation: Fraser C, Donnelly CA, Cauchemez S, et al. Pandemic potential of a strain of influenza A (H1N1): Early findings. Science. 2009 May 14; e-pub ahead of print. A team of epidemiologists has analyzed the influenza A (H1N1) epidemic in Mexico. Data related to the outbreak were …
Read More25 Sales and Marketing Pearls
This month’s column provides some easy-to-execute sales and marketing tips that we have found helpful in moving a clinic’s occupational health initiative forward: Sales Skills and Techniques Use euphemisms to convert negative phrases into positives. “You have a problem” should be “You have an opportunity.” “You have a high injury rate” becomes “if we can help lower your injury rate, it would result in lower workers’ comp costs.” Orchestrate clinic visits to make …
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