Unless you have spent the entire summer on Gilligan’s Island, I assume everyone remains attuned to the daily reports on H1N1 streaming from every which way but loose. While the prevailing opinion is that the flu season will be Superbad, it remains difficult to predict how things will play out. We will be dedicating the October issue of JUCM to pandemic flu planning, though given the likelihood of an early spike of flu, there are …
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September 2009
Developing Data: September, 2009
In early 2008, UCA revamped its annual survey in conjunction with researchers at Massachusetts General Hospital and Harvard University with the goal of assuring that the UCA Benchmarking Committee’s efforts produced a scientifically valid report. Here, we present some of the data from this landmark survey, to which 436 urgent care centers responded. In this issue: What clinical staff is working in urgent care centers?
Read MoreClinical Challenge: September, 2009
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.
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