The patient is an 80-year-old man who presents to urgent care with low back pain of two weeks duration. He is hemodynamically stable and has a normal neurological exam. His personal medical history reveals hypertension, for which he is being treated. Blood pressure is 140/80, pulse 63. View the x-ray 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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Diabetic Emergencies in the Urgent Care Setting
Urgent message: Patients with glucose levels either too high or too low often require immediate, potentially life-saving interventions in the urgent care setting. These patients are often found to be diabetic. Allan F. Moore, MD, Nicolas Abourizk, MD, Jeffrey Collins, MD, MA Diabetes is a common chronic disease affecting approximately 7% of the United States population. Of these individuals, 17.5 million carry a diagnosis of diabetes and over 6 million are undiagnosed. An estimated 54 …
Read MoreVisioning for the Future of Urgent Care
Lee A. Resnick, MD, FAAFP The Urgent Care Association’s spring convention in New Orleans, April 28–May 2 culminated an incredible year for our association. The convention was attended by 660 urgent care practitioners and administrators, and represented an incredible show of strength for our industry, the discipline of urgent care medicine, and UCA. As witnessed by those of you who have attended many of our recent conventions, UCA has achieved remarkable growth in only four …
Read MoreAbstracts In Urgent Care: May, 2008
Duration of IV Antibiotic Treatment for Children with Pyelonephritis Key point: Rates of renal scarring were similar in children who received long- or short-course IV antibiotics. Citation: Bouissou F, Munzer C, Decramer S, et al. Prospec- tive, randomized trial comparing short and long intravenous antibiotic treatment of acute pyelonephritis in children: Dimercaptosuccinic acid scintigraphic evaluation at 9 months. Pediatrics. 2008;121:e553-e560. Whether the mode and duration of antibiotic treatment prevent development of renal scars in children …
Read MoreClinical Challenge: May, 2008
This male patient presents to urgent care after, he claims, falling from a ladder. He refuses to give further details, except to say that the distance he fell was “not high.” View the x-ray 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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Prescription Drug Abuse and the Drug-Seeking Patient
Urgent message: The urgent care clinic is a prime target for prescription drug abusers seeking possibly inappropriate prescriptions. Clinicians must be vigilant to screen, intervene, and refer such patients. Marcelina Behnam, MD and Mark Rogers, MD Over the past several years, prescription drug abuse has become a problem of epidemic proportions for urgent care centers and emergency departments around the country. There has been an increase both in visits related to the acquisition of these …
Read MoreRekindling the Doctor-Patient Relationship
Lee A Resnick, MD, FAAFP The joy of practice is two-fold: Intellectual and Relational. The intellectual side of us thrives on the challenge of complex medical decision making and computational fact-finding. Understanding and applying pathophysiology is what we trained for, and what most of us consider to be a joyful brain exercise. However, since we do not practice medicine in a vacuum, the relational side of patient care is equally important to job satisfaction. It …
Read MoreAbstracts in Urgent Care: May 2008
The Case of a 71-Year-Old Man with Back Pain
Though it is easy to predict the usual etiology of common complaints, we need to be able to exclude life-threatening causes of symptoms. In law, we are innocent until proven guilty. In medicine, we are required to prove certain diseases are not occurring; we are, in a sense, guilty until proven innocent: A 50-year-old man with chest pain and diaphoresis has an MI until proven otherwise. A 22-year-old woman with lower abdominal pain has an …
Read MoreClinical Challenge: April, 2008
The patient is an 82-year-old man who presented after having fallen backwards and landing on his back. He did not lose consciousness; nor did he vomit. The patient entered the clinic using a walk- er, which he reported using on a regular basis. Examination revealed an abrasion over his forehead and over the anterior right tibia. The neurological exam showed no acute changes. The patient was specifically tender over the shoulder, but there was no …
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