The patient is a healthy 37-year-old who reports falling on his hand, with his thumb outstretched. Upon examination, you find local mild swelling and tenderness and decreased range of motion of the thumb. There is no snuffbox tenderness, however. View the x-rays 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: March, 2007
Acute Pain Management in Urgent Care Medicine
Urgent message: Urgent care practitioners are called upon daily to alleviate pain. A thorough understanding of the various pain syndromes and the pharmacology and analgesic potencies of various medications will aid in their safe and appropriate use. Marc R. Salzberg, MD, FACEP and Paolo T. Coppola, MD, FACEP Pain, either chronic or acute, is the main reason patients seek medical care. In this article, we will discuss acute pain management in an urgent care setting, …
Read MoreClinical Challenge: March, 2007
The patient is a healthy 30-year-old male who presents with pain shortly after “twisting” his ankle while playing soccer. Pain is severe enough to prevent him from putting weight on the ankle. There are no other remarkable findings from exam or patient history. View the x-rays 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: March, 2007
Single-Dose Oral Dexamethasone in the Emergency Management of Children with Exacerbations of Mild-to-Moderate Asthma Citation: Altamimi S, Robertson G, Jastaniah W, et al. Pediatr Emerg Care. 2006;22(12):786-793. URL: http://www.pec-online.com/pt/re/pec/home.htm Key point: Singe-dose dexamethasone is equivalent to five days of oral prednisone for kids with mild/moderate asthma. The purpose of this study was to compare the efficacy of a sin- gle dose of oral dexamethasone (dex) versus five days of twice-daily prednisolone (pred) in the management …
Read MoreFilling Your Emotional Tank
Lee A. Resnick, MD, FAAFP Nothing like a frigid winter day to inspire a discussion on emotional well-being; the final reserves of endorphins and serotonin that I stored away for the winter are almost depleted, flu season is upon us, wait-times are long, and everyone is cranky. Times like these remind me of the importance of refueling the emotional tank. This is not just a matter of feeling good, though that’s important, too. But physical …
Read MoreClinical Challenge 2 : February, 2007
A 78-year-old woman presents to your urgent care clinic with new onset palpitations that began a few hours before presentation. Upon examination, you find: Pulse is 123 Blood pressure is 152/83 The only existing issue she admits is hypertension, for which she is taking thiazides as Consider Figure 1, above, and what your possible diagnosis might be, based on the evidence available. Resolution of the case is on the next page. >!–nextpage–> Resolution The patient …
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Management of Acute Orofacial Pain Syndromes
Urgent message: The differential diagnosis of acute orofacial pain is wide ranging; prompt recognition of these syndromes is vital for ensuring the best possible outcome. John A. Vaughn, MD, Immediate Health Associates, Westerville, OH A cute orofacial pain—pain arising from the teeth or soft tissues of the mouth—is extremely common, affecting 22% of people in the United States. Since it is more likely to affect younger adults and those without adequate access to primary care, …
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Telephone Consultations From the Urgent Care Center: An Educational Model
Urgent message: Communication between UC providers and consultant physicians can facilitate timely, efficacious patient management OR it can damage trust between the treating physician and the consultant. Kenneth V. Iserson, MD, MBA, FACEP, FAAEM, Professor of Emergency Medicine, The University of Arizona, Tucson, AZ Urgent care providers, as much as or more than any other specialist, must call consultants to admit, refer, appropriately treat, or obtain follow-up for their patients. At many urgent care centers, …
Read MoreOn Antibiotic-Seeking, Predicting Prognosis in Rhinosinusitis and Mortality in Head Injuries, and When to Use Antibiotics in Conjunctivitis
Are Sore Throat Patients Who Hope for Antibiotics Actually Asking for Pain Relief? Citation: van Driel ML, De Sutter A, Deveugele M, et al. Ann Fam Med. 2006;4:484-485. URL: http://www.annfammed.org/cgi/content/full/4/6/494 Key point: The desire for pain relief is a strong predictor of the hope to receive a prescription for antibiotics. Antibiotics are still over prescribed for self-limiting upper respiratory tract infections such as acute sore throat; physicians point to patients’ desire for antibiotics as a …
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