Antibiotics Are Not Equal to Appendectomy for Appendicitis Keypoint: The incidence of peritonitis at 30 days was higher in the antibiotic group than in the surgery group; 68% of patients treated with antibiotics did not require appendectomy Citation: Vons C, Barry C, Pautrat K, etal. Amoxicillinplus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, ran- domised controlled trial. Lancet. 2011;377(9777): 1573-1579. Four recent randomized trials suggest that antibiotics alone can …
Read MoreTo Board or Not to Board…That Is the Question!
Lee A. Resnick, MD, FAAFP With the announcement of the Board of Certification in Urgent Care Medicine (BCUCM), an American Board of Physician Specialists (ABPS) member board, the urgent care community is abuzz about its meaning, value, and importance for specialty recognition of the discipline and professional identity for its physician practitioners. Some believe the American Board of Medical Specialties (ABMS) is the only body with the authority to anoint specialty certification and provide board …
Read MoreClinical Challenge: September, 2011
The patient, an otherwise healthy 18-yearold, presented with pain in the upper arm. There was no history of trauma. View the image taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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A Surprising Cause for Constipation?
Urgent message: Prescribing Miralax and an enema would likely have killed this patient. He nearly died in the hospital. Can you figure out why? WILLIAM A. GLUCKMAN, DO, MBA, FACEP, CPE, CPC Constipation, a common urgent care complaint, can be a symptom of many things, not all of them obvious, and some life-threatening. In this tricky case, the underlying problem is one that many urgent care physicians would not consider in a differential diagnosis, yet …
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Sudden Cardiac Death
Identifying Risk Factors in Preparticipation Physicals for Young Athletes Urgent message: Doctors in the US and Europe are divided over what the cardiovascular component of a proper sports physical should include. Here is a reasonable approach. NATHAN P. NEWMAN, MD, FAAFP Sudden death in young athletes is not new. In 490 BC, when the Greeks improbably defeated the invading Persians at Marathon, a young herald, Phidippides, ran 25 miles back to Athens to announce the …
Read MoreClinical Challenge 2: July 2011
The patient, an otherwise healthy 22- year-old, fell on his back and now is experiencing significant mid-back pain. View the image taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
Read MoreAbstracts in Urgent Care: July/August, 2011
Heparin-Binding Protein: A New Biomarker for Bacterial Meningitis Key point: A cerebrospinal fluid HBP level >20 ng/mL was 100% sensitive and 99.2% specific for bacterial meningitis in adults. Citation: Linder A, Akesson P, Studahl M, et al. Heparin- binding protein: a diagnostic marker of acute bacterial meningitis. Crit Care Med. 2011;39(4):812-817. To assess whether cerebrospinal fluid (CSF) levels of heparin- binding protein (HBP) can predict bacterial meningitis, re- searchers analyzed CSF samples in a prospective …
Read MoreClinical Challenge: July/August, 2011
The patient is a 37-year-old female who presents with a history of long-standing hypertension and diabetes mellitus. She had recently started on a new diuretic and felt very weak and light-headed. Her blood pressure was 88/56 mmHg with a pulse of 44 beats per minute. View the patient’s ECG (Figure 1). Consider the type of diuretic is she likely to be taking and what your next steps would be. Resolution of the case is described …
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Acute Stridor in Children
Urgent message: Acute stridor in pediatric patients is alarming to children, parents, and healthcare providers alike. Differential diagnosis is the key to initial evaluation and management of this worrisome symptom. Here is how to think it through. JERRI A. ROSE, MD, FAAP Stridor is an externally audible sound caused by abnormal air passage during breathing.1 It results from turbulent airflow through large airways. When a normal respiratory volume of air passes through narrowed airways, the …
Read MoreOur Infected Food Chain: Lessons from Groundhog Day
Lee A. Resnick, MD, FAAFP An E. coli outbreak, believed to have originated from a crop of bean sprouts in Northern Germany, has killed at least 36 people across Europe. Watching the public health “crisis” unfold, I can’t help but think of the 1993 comedy “Groundhog Day.” Phil Connors (Bill Murray), an egotistical meteorologist from Pittsburgh tasked with covering the annual Groundhog Day in Punxsutawney, Pennsylvania, finds himself caught in a time warp in which …
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