CAP Treatment Recommendations: Guided in the Right Direction Key point: Results of two large cohort studies indicate that adherence to guidelines for treating community-acquired pneumonia is a good thing. Citations: Arnold FW, LaJoie S, Brock GN, et al. Improving outcomes in elderly patients with community-acquired pneumonia by adhering to national guidelines: Community-Acquired Pneumonia Organization International Cohort Study results. Arch InternMed. 2009;169:1515-1524. McCabe C, Kirchner C, Zhang H, et al. Guideline-concordant therapy and reduced mortality and …
Read MoreClinical Challenge: January, 2010
The patient is a 16-year-old male who presents with difficulty breathing and pain in his throat, along with difficulty swallowing and pleuritic chest pain. All the symptoms began “a couple of hours” prior to presentation. There is no history of trauma or choking, nor of a recent dental procedure. On exam, the patient looks well, and is quiet and not toxic; there are no sign of distress. Pulse is 75, O2sat 94 and there is …
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Assessment, Intervention, and Disposition of Patients with Psychiatric Symptoms
Urgent message: Assessment of patients presenting with psychiatric conditions requires amodified set of skills compared with traditional medical assessment. Urgent care clinicians must be prepared to determine appropriate interventions—treatment, referral, or both. Gregory P. Brown, MD Introduction Typically, the interaction between clinicians and patients presenting with psychiatric conditions is guided by information obtained from the interview, history, and physical examination rather than emphasizing laboratory or radiological testing. Therapeutic options may be challenged by a lack …
Read MoreIn Support of a Pledge
If you are reading this, you should be a member of UCA. No cheating…keep reading. The Urgent Care Association (UCA) is your representative organization. Whether you are a practice administrator, biller, owner, physician, physician assistant, or nurse practitioner, UCA is doing the heavy lifting on your behalf to build the foundation of this industry and discipline. Consider the following: UCA was founded six years ago with the vision to be the catalyst for the recognition …
Read MoreInsights In Images
The patient is a 2 ½-year-old child whose parents report recurrent episodes of abdominal pain without vomiting or diarrhea. On exam, you note fullness of the abdomen. 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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Identifying and Treating Superficial Fungal Infections in the Urgent Care Setting
Urgent message: Rashes often lead patients to seek relief in the urgent care center. The ability to differentiate among common, superficial fungal infections and to select the most appropriate treatment or refer is an important skill to master. Kosta G. Skandamis, MD and George Skandamis, MD Introduction Superficial fungal infections are among the most common skin conditions seen in the urgent care setting. Dermatophytes are the most common type of fungi that infect and survive …
Read More‘Responsible Leadership:’ Questions and Answers
Q. “I’m a physician. I’ve paid my dues. Isn’t it enough to provide good care for my patients?” Q. “I’m an owner. I have a business to run, decisions to make, money to stake. Don’t I call the shots here?” Q. “I’m a manager, I have spreadsheets to analyze, schedules to make, sick calls … with all responsibilities, how can I be expected to find time to be a leader?” Q. “I’m a front desk …
Read MoreAbstracts in Urgent Care: December, 2009
Clinical Predictors of Pneumonia Among Children with Wheezing Key point: The routine use of chest radiography for children with wheezing but without fever should be discouraged. Citation: Mathews B, Shah S, Cleveland RH, et al. Clinical predictors of pneumonia among children with wheezing. Pediatrics. 2009; 124(1): e29-e36. A prospective cohort study was performed with children < 21 year of age who were evaluated in the ED, were found to have wheezing on examination, and had …
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A 12-year-old Girl with Back Pain
Urgent message: Back pain in a pediatric patient requires a high index of suspicion. Ominous causes (e.g. cancer, infection), are far more common in the pediatric population. Conversely, mechanical low back pain is far less common, and is a diagnosis of exclusion. Forrest Nguyen, DO Introduction As urgent care physicians, we are responsible for anything that comes through the door. Often, the diagnosis proves to be routine – a viral infection, a sore throat, or …
Read MoreClinical Challenge: December, 2009
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 93-year-old female who lost her balance and twisted her ankle. She presents with significant pain in the ankle and swelling over her lateral …
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