Evaluating Fever of Unidentifiable Source in Young Children Key point: An excellent review of the approach to the febrile child. Citation: Sur DK, Bukont EL. Am Fam Physician. 2007;75:1805- 1811. Even with a thorough history and a complete physical examination, one in five acutely ill, nontoxic-appearing children had an unidentifiable source of fever. Physicians should be cautious in their approach because of the potential for unrecognized and untreated serious bacterial infections (SBI). The review notes …
Read MoreClinical Challenge: September, 2007
The patient is a 10-monthold child who presents, with the parents upon referral by the pediatrician, with a history of three days of pain, but no history of trauma. The child refuses to stand, presumably due to pain, and resists crawling. 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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The Case of a 33-Year-Old Male with Abdominal Pain
Over the next few installments of this series, we will be discussing “bounceback” studies, and answering the following questions, in sequence: What is the incidence of bouncebacks? What is the incidence of bounceback admissions? What is the incidence of deaths 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? Our feeling is that if we can use these …
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Managing Heat Illness in Urgent Care
Urgent message: The urgent care provider’s most critical role in heat illness is to identify risk factors and the cause, to cool and hydrate the patient, assess for complications, and educate the patient in the hope of preventing a more serious exposure. Bridget Dyer, MD, Samuel Keim, MD, and Peter Rosen, MD Heat illness occurs when external heat conditions and internal heat production overwhelm the ability of the body to dissipate heat. Evaporation of sweat …
Read MoreLessons Learned
Lee A. Resnick, MD, FAAFP Between sticky ribs and spicy BBQ sauce, I mingled with the future generation of doctors at the annual AAFP Residents and Students Conference in Kansas City. I was reminded of several very important things… I am old I didn’t just finish my residency I need to get a “MySpace” account and learn how to “IM.” In addition to my mini-mid-life crisis, my booth was dead. I was sure there would …
Read MoreClinical Challenge: August, 2007
The patient is a 9-year-old boy who received a blow to the shoulder from a height of approximately 6 ½ feet. He has limited elevation of the arm due to pain. 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 MoreClinical Challenge 2: July 2007
The patient is an 18-year-old male who jumped or fell from a “short height” but landed hard on his heel. He is able to ambulate, but cannot put any pressure on his heel. 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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Management of Distal Radial Fractures in Young Patients by Non-Orthopedists in an Urgent Care Center
Wrist fracture is a common injury in children. 1 Many of these fractures are buckle or torus fractures. Traditionally, treatment for buckle fractures has been short-arm casting for two to four weeks.2 However, questions have been raised as to the need for such treatment. A number of recent studies have indicated that many such fractures may be managed without casting by the use of either elastic bandaging alone3 or splints.4-6 Plaster splints can easily be …
Read MoreAbstracts in Urgent Care: July/August, 2007
Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department with Syncope Key point: Syncope is a common presentation to the emergency department. These recommendations help stratify low- versus high-risk patients. Citation: Huff JS, Decker WW, Quinn JV, et al. Ann Emerg Med. 2007;49:431-444. American College of Emergency Physicians Issues Guidelines for Treatment of Syncope Citation: Barclay L. Medscape News. April 30, 2007. URL: http://www.medscape.com/viewarticle/ 555843?src=mp Syncope accounts …
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Challenges in Assessing and Treating Insect Bites and Stings
Urgent message: When presented with a patient who has experienced an insect bite or sting, the most crucial role for the urgent care clinician is to triage for anaphylaxis, venom toxicity, and local tissue damage. Kent A. Knauer, MD Now that summer is here, it is likely that urgent care practitioners—especially those practicing in suburban and rural areas—will see an increasing number of patients who have experienced an insect bite or sting. Though data are …
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