The patient, an otherwise healthy 16-year-old, fell and suffered a blow to the wrist one hour prior to presentation.
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A Case of Acute Pancreatitis
Urgent message: Although pancreatitis is a common cause of abdominal pain, many of its signs and symptoms are shared by other intraabdominal conditions. Most patients can be handled on an outpatient basis if diagnosis is accurate, as this case illustrates. MICHAEL TALKAR, MD Abdominal pain is a common and varied presentation in urgent care. A history and physical exam can be used to triage the majority of emergent cases. Strong communication is vital to ensuring …
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Acute MI After a Normal Stress Test
Urgent message: Evaluation of chest pain in the low-risk patient can be daunting. This case, in which the patient had no known history of cardiovascular disease, exemplifies the challenge. MARREN J. WEBER, DO The standard treadmill exercise tolerance test (ETT) and echocardiography are widely used as the initial tests of choice for prediction of cardiovascular disease. Historically stress echocardiography has been recognized to perform well in predicting mortality in conjunction with clinical data and other …
Read MoreIn Appreciation…
Lee A. Resnick, MD, FAAFP JUCM, The Journal of Urgent Care Medicine, is approaching its fifth year of publication (a feat not without reason for celebration). In an environment of tremendous financial pressures, increasing scrutiny, and decreasing ad revenues, medical publishing is confronting significant challenges. JUCMis not immune. Most casual readers remain unaware of the challenges behind the scenes. It is, perhaps, no concern of theirs. But that does not mean the efforts should go …
Read MoreAnaphylaxis: Clinical Guidelines for Diagnosis and Management
Urgent message: Anaphylaxis is a true medical emergency that requires rapid and aggressive treatment. When a patient with a Type 1 hyper – sensitivity reaction is brought to your urgent care, here is how to proceed. DAVID WEIN, MD, MBA, FACEP, and DENNIS DIXON, MD Introduction Anaphylaxis is a severe, whole-body, allergic reaction to a chemical that has become an allergen. Anaphylaxis is a true medical emergency, often with a rapid and unpredictable onset. It …
Read MoreAbstracts in Urgent Care: June, 2011
When Should Diagnostic Imaging Be Used for Patients With Low-back Pain? Key point: With low-back pain, the risks associated with X-rays and MRIs often outweigh the benefits. Citation: Daily POEM: imaging for low-back pain: rarely indicated, often harmful. Available at: www.essentialevidience- plus.com. These guidelines are based on a systematic review and meta- analysis of research investigating the usefulness of various im- aging studies in patients with low-back pain. Based on a meta- analysis of six …
Read MoreClinical Challenge: June, 2011
The patient is an otherwise healthy child, age 11, who presents with acute pain to the wrist following a blow. 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 MoreClinical Challenge 2: May, 2011
The patient is an otherwise healthy 22-year-old male who presents with three weeks of cough. He has already been treated with a macrolide. View the image taken (Figure 1) and consider what your diagnosis and next steps would be.
Read MoreAbstracts in Urgent Care: May, 2011
Complications of Sinusitis in Children Key point: Intracranial complications of pediatric sinusitis were more severe than intraorbital complications. Citation: Goytia VK, Giannoni CM, Edwards MS. Intraorbital and intracranial extension of sinusitis: Comparative morbidity.  J Pediatr. 2011;158(3):486-491. Serious complications of sinusitis occur more often in children than in adults. Prompt diagnosis and treatment are necessary to minimize morbidity and the risk for permanent sequelae or death. In arecent study, investigators reviewed records from a large chil- …
Read MoreClinical Challenge: May, 2011
The patient is an otherwise healthy child, 3.5 years of age, who presents with acute pain in his right lower arm to the elbow. Examination reveals multiple fractures. 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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