Lee A. Resnick, MD, FAAFP Brian Sipe’s “Red Right 88.” John Elway’s “The Drive.” Earnest Byner’s “The Fumble.” Michael Jordan’s “The Shot.” Jose Mesa’s “The Choke.” And now, the Cavs’ and “The Sweep.” You’ve just read an abridged version of the History of Cleveland Sports. For those of you who have no interest in sports, fear not; there’s an analogy in here somewhere. Growing up a Cleveland sports fan has been a roller coaster ride …
Read MoreClinical Challenge 2: June 2007
The patient is a young child with three days of constipation with a non-specific history of abdominal pain. On exam, the child was asleep. The abdomen was easily palpable and soft. View the x-ray taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described below.
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The Case of an 18-Year-Old Male with Hand Pain
Urgent message: A thorough history and physical exam are essential to positive outcomes and risk reduction when managing patients with hand injuries. Michael B. Weinstock, MD and Ryan Longstreth, MD, FACEP Bouncebacks, in which we recount scenarios of actual patients who were evaluated in and discharged from an emergency department or urgent care facility and then “bounced back” for further treatment, appears semi-monthly in JUCM. Case presentations on each patient, along with case-by-case risk management …
Read MoreUCA: A Vision for the Future
Lee A. Resnick, MD, FAAFP The UCA National Conference, held last month in Daytona Beach, FL, was an important milestone in the organizational evolution of UCA: The elections conducted at the meeting marked the second rotation of board seats since our founding in 2004, and the first board election of a new president. It is critical to the success of our organization to have a rotating leadership at the board and officer levels. Our bylaws …
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Management of Patients Presenting with symptoms of Vulvovaginitis
Urgent message: As the cause of approximately 10 million office visits in the United States annually, vulvovaginitis remains a common but important complaint seen in the urgent care setting. Jansen Tiongson, MD, Samuel Keim, MD, and Peter Rosen, MD Although numerous etiologies account for vulvovaginitis, the vast majority of cases are due to bacterial vaginosis (BV), trichomoniasis, and vulvovaginal candidiasis (VVC). BV causes 40% to 50% of all cases, while candidiasis and trichomoniasis account for …
Read MoreAbstracts in Urgent Care: June, 2007
Evaluation of the Utility of Radiography in Acute Bronchiolitis Key point: Infants with typical bronchiolitis (clinically O2sat>92% and mild/moderate distress) do not need imaging. Citation: Schuh S, Lalani A, Allen U, et al. J Pediatr. 2007;150: 429-433. URL: http://sitemaker.umich.edu/emjournalclub/article_database/ da.data/1619753/PDF/bronchiolitis_xray_j_pediatrics.pdf The purpose of this study was to determine the proportion of radiographs inconsistent with bronchiolitis in children with typical presentation of bronchiolitis and to compare rates of intended antibiotic therapy before radiography versus those given …
Read MoreClinical Challenge: June, 2007
The patient is a 15-year-old boy who presents with pain in the wrist 40 minutes after stopping a soccer ball with his hand. There is no snuffbox tenderness. 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: May 2007
The patient is a 13-year-old male who presented to urgent care after taking a fall while running; he landed on his outstretched left hand. Upon examination, you find tenderness in the snuff box and observe swelling around the wrist. 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 MoreThe Road to Recognition
Lee A. Resnick, MD, FAAFP The recent announcement that the American Board of Medical Specialties approved Hospice and Palliative Care as a new subspecialty appears to ring in a new era of subspecialty acceptance. It was once thought that subspecialties found their homes with one sponsor; Cardiology, Gastroenterology, and Pulmonology were all within the realm of Internal Medicine. Pediatrics followed suit with its own versions of these subspecialties. There was no con-joint sponsorship from multiple …
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Management of Erythema Multiforme in the Urgent Care Setting
Urgent message: With the increasing use of medications, especially antibiotics, more and more patients are presenting to urgent care with erythema multiforme. Correct diagnosis and identification of the underlying cause can result in rapid clinical resolution of the lesions. Shailendra Kapoor, MD Descriptions of erythema multiforme (EM) first appeared in the work of Albert and Bazin in 1822, but it was not until 1866 that von Hebra categorized these erythematous eruptions and labeled them “erythema …
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