Journal of Urgent Care Medicine

Clinical Challenge: October, 2010

In each issue, JUCM will challenge your diagnostic acumen with a glimpse of x-rays, electrocardiograms, and photographs of dermatologic conditions that real urgent care patients have presented with. If you would like to submit a case for consideration, please e-mail the relevant materials and presenting information to [email protected]. A 17-year-old patient presents with a “twisted” left knee sustained in a fall, able to bear weight despite obvious pain. View the image taken (Figure 1) and …

The Case of a 51-year-old Man with Back Pain

Most new third-year medical students can recite the “red flags” of back pain: extremes of age, fever, history of cancer, history of trauma, failure to improve after one month of therapy. Few would fail to consider metastatic disease in a 64-yearold woman with a history of breast cancer and new-onset low back pain, but what about the 51-year-old male without a significant past medical history?

Clinical Challenge 2: September 2010

The patient is a 32-year-old man who presents after experiencing a blow to the face while falling from a bicycle. The patient complains of tenderness over the front of his face. Neurological exam is normal. You note that his neck is supple. 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.

Abstracts in Urgent Care: September, 2010

Non-intravenous Midazolam Effectively Terminates Pediatric Seizures Key point: A meta-analysis revelas that non-IV midazolam is as effective as or superior to IV or rectal diazepam for stopping seizures in children and young adults. Citation: McMullan J, Comilla S, Panciolo A, et al. Midazolam versus diazepam for the treatment of status epilepticus in children and young adults: A meta-analysis. Acad Emerg Med. 2010; 17(6): 575-582. Although intravenous (IV) lorazepam is considered first-line therapy for status epilepticus, …

Clinical Challenge: September, 2010

In each issue, JUCM will challenge your diagnostic acumen with a glimpse of x-rays, electrocardiograms, and photographs of dermatologic conditions that real urgent care patients have presented with. If you would like to submit a case for consideration, please e-mail the relevant materials and presenting information to [email protected]. The patient is a 62-year-old who presents with a primary complaint of right shoulder pain that developed over time. The patient denies any trauma. The patient is …

Promethazine-induced Tissue Necrosis: A Case Presentation

Urgent message: Due to versatility, the urgent care clinician will find promethazine an appropriate choice in many situations. Awareness of potentially serious side effects maximizes the chance of good outcomes while minimizing risk. Shailendra Saxena, MD, PhD, Naureen Rafiq, MD, Liji George, MD, Cara Olsen, PharmD, and Mikayla Spangler, PharmD Introduction Promethazine (Phenergan) is a drug commonly prescribed in emergency departments and urgent care clinics for treatment of a variety of conditions (Table 1). Because …

Providing DOT Medical Certification Exams for Commercial Drivers

Urgent message: The Department of Transportation’s responsibility to ensure that commercial drivers are physically qualified to operate in interstate commerce can mean new business for urgent care providers who qualify to perform certification exams. Ellison H. Wittels, MD, FACP The Federal Motor Carrier Safety Administration (FMCSA) – one of nine operating administrations within the United States Department of Transportation (DOT; Table 1) – is tasked with regulating commercial trucks and buses in interstate commerce. That …

Physician Recruiting: Standing Out in a Crowd

Urgent care is growing by hundreds of centers each year, and available physicians are declining with equal speed. urgent care training is variable, at best, and urgent care experience is hard to find. Expanding health systems with their in-house recruiters and high visibility are tightening the squeeze. All told, it’s a recipe for unfilled positions and staff burnout. Whether you are looking to expand locations, add providers, or replace departing ones, you are bound to …

Clinical Challenge 2

The patient is a 61-year-old male who presents with back pain. The patient’s abdomen is soft. Vitals are stable. 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.

Abstracts in Urgent Care: July/August, 2010

Validation of the ABCD2 Score for Predicting Stroke Risk After Transient Ischemic Attack Key point: An ABCD2 score > 2 is associated with significantly increased risk for stroke within 90 days. Citation: Tsivgoulis G, Stamboulis E, Sharma VK, et al. Multicenter external validation of the ABCD2 score in triaging TIA patients. Neurology. 2010; 74(17): 1351-1357. The ABCD2 score has been endorse internationally as a simple method for identifying patients with transient ischemic attack (TIA) who …