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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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 …
Read MoreA 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. …
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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 …
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