Abstracts in Urgent Care: April, 2009
Should the Elbow Extension Test Be Used to Rule Out Bony Injury? Key point: Full elbow extension had a negative predictive value for fracture of 98.4% in adults and 95.8% in children. Citation: Appelboam A, Reuben AD, Benger JR, et al. Elbow extension test to rule out elbow fracture: Multicentre, prospective validation and observational study of diagnostic accuracy in adults and children. BMJ. 2008; 337: a2428. The objective of this study was to determine whether …
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The Case of a 49-Year-Old Woman with Pleuritic Chest Pain
In our last Bouncebacks article, we explored the difficulties that arise when the patient and doctor disagree on treatment through the case of a 28-year old pregnant patient who left against medical advice (JUCM, February 2009). In the second part of this series, we present a case which explores differences in expectations between a patient and the physicians.
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Management of Hypertensive Urgency in an Urgent Care Setting
Urgent message: Effective management of patients presenting to urgent care with acute high blood pressure starts with differentiating between hypertensive emergency and hypertensive urgency and ends with appropriate treatment and counseling. Sanjeev Sharma, MD, Christy Anderson, PharmD, Poonam Sharma, MD, and Donald Frey, MD Introduction Urgent care physicians routinely encounter patients with high blood pressure, but management – particularly for those patients with precarious elevations – remains controversial. Alternative options involve the use of various …
Read MoreThe Responsibility of Torch Bearing
It is a time-honored Olympic tradition: passing the torch around the world from one runner to another, until it reaches the Olympic venue and lights the Olympic flame that burns for the duration of the games. It is a real privilege to carry the torch, and only a select few can be chosen for the honor. Each runner has a few simple tasks: run a few miles with the torch, try not to stumble, avoid …
Read MoreClinical Challenge: April, 2009
The patient is a 17-year-old male who presents with a complaint of throat pain. He reports a history of colitis, for which he was treated with mesalamine and prednisone, 20 mg/day. On exam, you discover that he is also experiencing pressure over his chest. Blood pressure is 97/60, pulse is 93, and SAT is 97%. He is afebrile. you find no abnormalities except for crepitations over his left shoulder soft tissue. View the x-ray taken …
Read MoreAbstracts in Urgent Care – March 2009
Beware of Eyewitness Accounts of Syncope or Seizures Key point: Bystanders’ descriptions of acute neurologic events often are simply wrong. Citation: Thijs RD, Wagenaar WA, Middelkoop HAM, et al. Transient loss of consciousness through the eyes of a witness. Neurology. 2008; 71: 1713-1718. Diagnosis of sudden catastrophic illness depends a good deal on eyewitness accounts. But, as criminologists know, eyewitnesses can be unreliable. Now, a team of neurologists in the Netherlands has reconfirmed this finding. …
Read MoreEvaluation and Management of Lower Extremity Edema
Urgent message: The high specificity but broad range of possible causes associated with a primary complaint of lower extremity edema poses a particular challenge to the urgent care clinician. Proper assessment of the differential diagnoses is the first step toward optimal outcomes, whether they be facilitated by treatment or referral. Michael S. Miller, DO Patients presenting to urgent care with a primary complaint of edema of the lower extremities of any duration can pose a …
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A Patient with Suspected Pulmonary Embolism
Urgent message: High degree of suspicion combined with thorough history and proper use of available tests can help the clinician identify patients in need of emergent referral. John Shufeldt, MD, JD, MBA, FACEP and Kelli Hickle Introduction A 47-year-old woman with a diagnosis of ovarian cancer developed an acute onset of mild shortness of breath two days after being discharged for a work-up of symptomatic ascites. Her medical history was significant for obesity and recent …
Read MoreUrgent Care Without a Paddle
Economy getting you down. Feeling like you’re up the veritable creek. Whether you’re an owner, manager, or practitioner, if you’re not feeling the heat, you should be. That’s not to say you should get out of the kitchen; just be a better chef. There has never been a crisis in history that did not create great opportunity for those who know how to find it. During a crisis of any kind, two classes of people …
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