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, …
Read MoreClinical 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 …
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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 …
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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 …
Read MorePhysician 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 …
Read MoreClinical 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.
Read MoreAbstracts 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 …
Read MoreClinical Challenge: July/August, 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 42-year-old who presents to urgent care after “twisting” her left foot. The patient is able to bear weight on the foot, though it …
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Tuberculosis Screening in Urgent Care Medicine
Urgent message: Often placed in the role of first-line clinicians with respect to testing for and treating infectious disease, urgent care practitioners are ideally suited to provide screening services for tuberculosis. Introduction In addition to urgent care services, many of us also offer occupational medicine and provide post-offer/pre-employment evaluations. As such, urgent care clinicians play a key role in screening for tuberculosis (TB). In fact, understanding the complexity of the screening process is essential to …
Read MoreHealthcare’s Title Bout: Free Market Economics KOs Reform
At the risk of oversimplifying, the healthcare “crisis” – and subsequent attempts to “reform” it – really boils down to a coverage crisis and a cost crisis. The two, of course, are inextricably linked. Ans every attempt to solve one seems to exacerbate the other. Our healthcare delivery system has essentially failed to manage cost and manage coverage simultaneously. The teeter-totter is perpetually imbalanced. The problem with reform efforts to date is complex. However, the …
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