Non-Steroidal Anti-Inflammatory Drugs for Low-Back Pain (Review) Key point: NSAIDS are more effective than placebo, are all similar in efficacy, and do have significant side effects. COX- 2 seems to have fewer side effects; however, the recent data on CV side effects is a concern. Citation: Roelofs PDDM, Deyo RA, Koes BW, et al. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD000396. Â DOI: 10.1002/14651858.CD000396.pub3. The authors searched the MEDLINE and EMBASE databases …
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Minor Traumatic Brain Injury: Applying the Evidence to Urgent Care
Urgent message: While few data specific to the urgent care setting exist, applying the medical evidence gleaned from other acute care settings can enable the clinician to effect positive outcomes in patients presenting with symptoms indicative of minor TBI. Joseph Toscano, MD Head trauma is among the most important problems evaluated in acute-care medicine. Estimates from the Centers for Disease Control and Prevention indicate that each year in the Unites States, approximately 1.4 million individuals …
Read MoreNotes From the Field
Lee A. Resnick, MD, FAAFP I write to you from the beautiful landscapes of New Zealand, where I just participated in the first-ever international conference for urgent care. Representatives from all over the world joined to share ideas and experiences of their journeys into the development of urgent care as a discipline and an industry. This international dialogue broadens our understanding of the clinical and market forces driving this global phenomenon, and strengthens our individual …
Read MoreClinical Challenge: March, 2008
The patient is a 15-year-old boy who presented two days after experiencing a blow to both ankles and the right knee. He could bear weight minimally, with tenderness over the lateral and medial malleolus, as well as over the knee. There was marked swelling View the x-rays 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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The Case of a 10-Year-Old Male with Eye Pain
Other than these medical errors, dyspnea and advanced age were the two most common factors associated with an unscheduled return visit. What is the incidence of bouncebacks? What is the incidence of bounceback admissions? What is the inci- dence of death in patients recently discharged from the ED? What percent of bouncebacks occur because of medical errors? How can we use this information to improve patient safety? This month, we will discuss Question IV: What …
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Understanding Clinical Decision Rules Regarding Minor Traumatic Brain Injury
Urgent message: Patients with minor traumatic brain injury can be difficult to assess. Identifying those at risk for poor outcomes is critically important in the urgent care setting. Joseph Toscano, MD The term traumatic brain injury (TBI) describes various injury patterns that result from force being absorbed by the brain after a rapid acceleration or deceleration or head impact. TBIs can span a spectrum from minor changes to fatal catastrophes and can affect patients in …
Read MoreStrength in Numbers
Lee A. Resnick, MD, FAAFP It’s springtime again, and for us Northerners, that is a welcome sign. It’s time to end months of hibernation holed up in our overly heated homes. It’s time to break out of our winter routine of work, eat, and sleep and welcome in several months of energizing warmth and rejuvenated spirit. At UCA, we use this time of year to re-energize the membership, welcome in new members, and set the …
Read MoreClinical Challenge 2: February 2008
The patient is a 3 ½-year-old girl who fell from a bicycle, receiving a blow to the elbow a short time before presentation. She had marked swelling and local tenderness over the elbow. The only other remarkable finding was a pulse of 132. 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.
Read MoreAbstracts In Urgent Care: February, 2008
Over the Counter but No Longer Under the Radar—Pediatric Cough and Cold Medications Key point: Since 1985, all six controlled studies of cough/cold preparations in children have not shown a positive effect. Over the last 7 years, poison-control centers have reported more than 750,000 calls Citation: Sharfstein JM, North M, Serwint JR. N Engl J Med. 2007;357(23):2321-2324. In recent weeks, over-the-counter cough and cold medications for children have received unprecedented attention from reg- ulators, physicians, …
Read MoreClinical Challenge: February, 2008
The patient is a 9-year-old girl who fell and received a blow to her right chest. A few hours later, she presented to urgent care complaining of pain on deep breathing. On exam, you find a pulse of 103, and SAT of 96. She is not in respiratory distress; her chest exam was clear and she has an abrasion over her right chest. She is generally healthy, is on no medica- tions, and has no …
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