Practice Management
Urgent message: Patients presenting to urgent care in the wake of a motor vehicle accident have self-selected their treatment setting. However, it is imperative to maintain vigilance for potentially serious and even life-threatening injuries that may not be apparent. Gloria I. Kim, MD and Jill C. Miller, MD According to the National Center for Health Statistics, motor vehicle accidents (MVAs) accounted for nearly 5 million ED visits in 2006. The diverse injuries may be temporary, …
Read MoreUnless you have spent the entire summer on Gilligan’s Island, I assume everyone remains attuned to the daily reports on H1N1 streaming from every which way but loose. While the prevailing opinion is that the flu season will be Superbad, it remains difficult to predict how things will play out. We will be dedicating the October issue of JUCM to pandemic flu planning, though given the likelihood of an early spike of flu, there are …
Read MoreA 62-year-old female presents to the urgent care center with a three-week history of a pruritic facial rash that initiated on one cheek, then spread to the rest of the face. The patient states the rash got worse after sun exposure. Initially, she self-treated with cold cream, Eucerin, and other over-the-counter moisturizers that did not help. Eventually, the patient tried a topical hydrocortisone cream that made the rash much worse. You note there is no …
Read MoreH1N1 Update: CDC Recommends Seasonal Flu Vaccination for Children Over 6 Months Key point: Get vaccinated! Citation: Fiore AE, Shay DK, Broder K, et al. Prevention and control of seasonal influenza with vaccines. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR. July 24, 2009; 58 (Early Release): 1-52. Available at: www.cdc.gov/mmwr/preview/mmwrhtml/rr58e0724a1.htm. In contrast to last year, when seasonal flu shots for those between 6 months and 18 years of age were “encouraged,” …
Read MoreThe patient is a 45-year-old woman (herself a surgeon) who presented three weeks after first visiting her family physician with a cough, at which time the x-ray shown in Figure 1 was taken. She was started on erythromycin for 10 days. After finishing that course of antibiotics with no improvement, she was started on amoxicillin-clavulanic acid. Four days later, there was still no improvement in her status. Second Presentation: Urgent Care By the time the …
Read MoreUrgent message: Fractures of the distal radius are a common presentation in the urgent care setting. Nonetheless, a high index of suspicion is required for the diagnosis of a Galeazzi fracture–dislocation.By Heather L Hinshelwood, MD and David Caro, MD IntroductionThe anatomic structure of the forearm typically maintains the integrity of the distal radioulnar joint when the radius is fractured. However, in certain situations this joint may be compromised with certain rotational forces. CaseA 14-year-old African-American male …
Read MoreEarly Estimate of Pandemic Potential of Influenza A H1N1 “Swine Flu” Key point: The current virus is transmitted efficiently but probably is less lethal than past pandemic viruses. Citation: Fraser C, Donnelly CA, Cauchemez S, et al. Pandemic potential of a strain of influenza A (H1N1): Early findings. Science. 2009 May 14; e-pub ahead of print. A team of epidemiologists has analyzed the influenza A (H1N1) epidemic in Mexico. Data related to the outbreak were …
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Urgent message: Effective management of head lacerations starts with hemorrhage control but also requires an understanding of appropriate use of anesthesia, the possibility of closed head or nerve injury, and vigilance for non-accidental trauma. Clayton Josephy, MD, Samuel M. Keim, MD, MS, and Paper Rosen, MD Introduction Laceration repair is a common and important responsibility of physicians in the emergency and urgent care settings. A recent review of national trends in ED visits revealed that …
Read MoreWith healthcare reform imminent, the question on everyone’s mind is: “How will this impact me?” While there is almost universal support for reform – what you might call the why of a healthcare fix – there is considerable disagreement about the how, when, who, and where. While the details of reform may change a bit over the next several months, there are a few things we should consider invariable: The Democrats’ solid control of the …
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