H1N1 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 MoreCommunity-acquired Pneumonia
The 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 MoreGaleazzi Fracture–Dislocation of the Wrist or Isolated Distal Radius Fracture?
Urgent 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 MoreAbstracts in Urgent Care: July/August, 2009
Early 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 …
Read More
Common Lacerations of the Head
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 More‘What to Expect When You’re Expecting’: The Birth of a Public Health Plan
With 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 …
Read MoreClinical Challenge: July/August, 2009
The Story of Jonathan— One Week in January
The Patient’s Perspective Jonathan is a young man who changed the course of musical theatre and would still be making history today if things had turned out differently. Jonathan was born in Mount Vernon, NY in 1960. When he was 22, he moved to New York City to pursue his dream of writing a musical. Like most struggling artists, life wasn’t easy. He spent weekends waiting tables at the Moondance Diner in Soho. He spent …
Read More
Appendicitis Due to Squirrel Dinner
Introduction Appendicitis due to foreign bodies is a rare occurrence; most cases reported in the literature have occurred due to sharp objects such as pins, needles, toothpicks, and small nails. Solid foreign bodies – such as a bullet – rarely cause appendicitis. Appendicitis due to traumatic gunshot wounds has been described before, as have appendicitis cases due to ingested birdshot. Here, we describe an interesting case that demonstrates the importance of eliciting a history of …
Read MoreAbstracts in Urgent Care: June, 2009
Incidence of AMI in Patients with Syncope Key point: In a cohort study of nearly 1,500 patients presented without ST-segment elevation. Citation: McDermott D, Quinn JV, Murphy CE. Acute myocardial infarction in patients with syncope. CJEM. 2009; 11: 156-160. Which patients with syncope require hospital admission? To answer this question, researchers studied the incidence of acute myocardial infarction within 30 days of presentation in a cohort of 1,474 consecutive emergency department patients who presented with …
Read More