Are Cardiac Risk Factors of Value in ED Diagnosis of ACS? Citation: Zane RD. J Watch Emerg Med. March 9, 2007. URL: http://emergency-medicine.jwatch.org/cgi/content/ full/2007/309/3?q=etoc The Role of Cardiac Risk Factor Burden in Diagnosing Acute Coronary Syndromes in the Emergency Department Setting Citation: Han JH, Lindsell CJ, Storrow AB, et al. Ann Emerg Med. 2007;(2):145-152. Epub Dec 4, 2006. URL: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve& db=pubmed&list_uids=17145112&dopt=Abstract Key point: Cardiac risk factors are of no discriminatory value in emergent evaluation …
Read MoreClinical Challenge: May, 2007
The patient is a 2½-year-old female who presented after falling, unobserved, from an unknown height with tenderness and swelling around the elbow. Neurovascular exam was normal. 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. Resulotion The correct diagnosis is a supracondylar fracture; note the loss of the normal angle at the distal humerus. The injury was managed …
Read MoreClinical Challenge 2: April, 2007
The patient is a 25-year-old male who presented to urgent care after falling from a height of two stories, landing flat on his feet. He is able to ambulate, though only with pain. In addition, he complains of back pain. He is generally healthy, and no neurological deficit was found. View the x-ray taken (Figure 1) and consider what your next steps would be. Resolution of the case is described on the next page.
Read MoreAbstracts in Urgent Care: April, 2007
Computed Tomography Coronary Angiography for Rapid Disposition of Low- risk Emergency Department Patients with Chest Pain Syndromes Citation: Hollander JE, Litt HI, Chase M, et al. Acad Emerg Med. 2007;14(2):112-116. URL: http://www.aemj.org/cgi/content/abstract/14/2/112 Key point: CT coronary angiography may safely allow rapid dis- charge of patients with negative studies. Patients with recent normal cardiac catheterization are at low risk for complications of ischemic chest pain. Computed tomography coronary angiography has high correlation with cardiac catheterization for …
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A 55-Year-Old Woman with Abdominal Pain
Urgent message: Noting ‘red flags’ specific to the individual patient is of key importance when details of the presentation do not add up. Jill Chavinson Miller, MD J.W. is a 55-year-old female non-smoker who presented with abdominal pain. She reported that the pain woke her up the night before and lasted all day long, which prevented her from doing much that day. She described the pain as constant and gnawing, assessing its severity as 6 …
Read MoreA 45-Year-Old Man with Cough and Sore Throat: A Two-Step Approach to Avoiding a Bounceback
Urgent message: The clinician must address unexpected findings with further questions or testing. Michael B. Weinstock, MD and Ryan Longstreth, MD, FACEP This is the first article in a series that will appear every other month in JUCM, in which we will recount scenarios of actual patients who presented to an emergency department or urgent care facility, were evaluated and discharged, and then “bounced back.” Each of these cases is detailed in the book Bouncebacks! …
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An Approach to Care of Injured Workers
Urgent message: Appropriate treatment of workplace injuries and illnesses minimizes long-term disability while promoting rapid return to work and safer work environments. David M. Rosenberg, MD, MPH Physicians rendering care to injured workers must be knowledgeable regarding these injuries and the necessary types of treatment. Also, they must provide this care in an empathetic and caring manner, coupled with aggressive intervention to promote prompt healing. However, physicians must also realize that early return to work …
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The Dizzy Patient in the Urgent Care Setting
Urgent message: “Dizziness” can prove to be one of the more vexing complaints encountered in urgent care. To provide appropriate care, the clinician must understand whether the patient is experiencing near-syncope, disequilibrium, ill-defined light-headedness, or vertigo. Martin Samuels, MD, DSc (hon), FAAN, MACP The problem of dizziness can be one of the most exasperating in the practice of medicine. Physicians all know that sinking feeling elicited by the patient who sits down and, when one …
Read MoreClinical Challenge: April, 2007
The patient is a 3-year-old female who presented after a fall while running and complaining of pain over the foot. There was minimal local tenderness over the foot and minimal limp, but no other remarkable findings. View the x-ray taken (Figure 1) and consider what your next steps would be. Resolution of the case is described on the next page.
Read MoreLessons Born of Missteps
Lee A. Resnick, MD, FAAFP This month’s issue of JUCM heralds an important addition to the journal. “Bouncebacks” will be a new regularly occurring contribution from Dr. Michael Weinstock and Dr. Ryan Longstreth. This department will take a unique approach that combines the formats of a morbidity & mortality conference, risk management lecture, and clinical review article. The result is a one-of-a-kind look at relevant clinical cases seen in the urgent care or emergency department …
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