Journal of Urgent Care Medicine

Integration of Pharmacologic and Non-pharmacologic Techniques to Enhance Pediatric Minor Procedures

Urgent message: Integration of various techniques when performing minor procedures on children can enhance clinical care for patients and families while bringing within reach administrative and financial goals. Emory Petrack, MD, FAAP, FACEP, Lisa S. Perry, CCLS, and Kristine Vehar, RN As the practice of urgent care medicine continues to grow, urgent care centers grapple with several important issues, among them the needs to provide optimal clinical care, reduce medical legal risk, and deliver excellence …

A Field Guide to Evaluating Medical Literature

Lee A. Resnick, MD, FAAFP Urgent care medicine is a rapidly evolving discipline. Out of this evolutionary process, scientific skepticism is naturally born. It is the checks and balances of medicine, ensuring that what is purported to be true, is in fact based on evidence, not speculation. We welcome this inquiry and support the process necessary to lend legitimacy to what has been mere estimation and speculation, thus far, in the development of our discipline. …

A 4-Year-Old Who Fell from the Slide

Urgent message: Injuries sustained in playground falls are common presentations to emergency departments and urgent care centers alike. The urgent care physician should be alert to the keys to evaluation and management of traumatic neck pain. Muhammad Waseem, MD, Lalithambal Venugopalan, MD, and Gerard Devas, MD Cervical spine (C-spine) injuries occur infrequently in children. This is especially true for fractures of atlas vertebra, which is a rare injury in children. Its diagnosis may easily be …

The Case of a 17-Year-Old Male with Fever and Headache

This month, we will discuss Question III: What is the incidence of deaths in patients recently discharged from the ED? In May 2007, Sklar et al performed a very interesting study concerning deaths that occurred within seven days of ED discharge. A similar study had been done in 1994 by Kefer et al, looking at medical examiner cases. Sklar’s study, however, is more likely to have captured all unanticipated deaths because it was performed at …

Clinical Challenge: January, 2008

The patient is a 26-year-old male who slipped and twisted his left ankle. He is unable to bear weight on the ankle and there is marked local swelling circumferentially around the ankle. Oth erwise, he is generally healthy. View the x-ray taken (Figure 1) and consider what your diag- nosis and next steps would be. Resolution of the case is described on the next page.

CA-MRSA Abscess Care and Treatment Guidelines in Urgent Care Practice

Urgent message: In the absence of controlled outpatient trials, the author proposes urgent-care specific guidelines for treatment of community-acquired MRSA, informed by clinical experience and local and regional case reports. Michael Dickey, MD The goal of any treatment is to maximize the chance of a positive outcome for a patient. The purpose of a treatment guideline is to maximize the chance of positive outcomes in groups of patients that present with a similar disease states. …

Clinical Challenge: January, 2008

Quantifying Urgent Care, Defining Our Industry

Lee A. Resnick, MD, FAAFP Have you ever wondered how many urgent care centers there are in the U.S.? So did UCA. Partnering with researchers at Harvard University and Massachusetts General Hospital, UCA has completed the first-ever sampling frame of urgent care centers across the country. Our goal was to produce an objective, scientifically valid assessment of the size of the urgent care industry. Estimates have flown around the industry for years, but until now …

Clinical Challenge 2: December 2007

The patient is a 10-year-old boy who received a blow to the forearm when he fell at home. He presented with local swelling and tenderness on exam, complaining of severe pain in his wrist. View the x-rays taken (Figure 1 and Figure 2) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.