Journal of Urgent Care Medicine

An Urgent Care Approach to Joint and Soft-Tissue Injection/ Aspiration: Part 2

Urgent message: Injection/aspiration therapy for selected musculoskeletal complaints is becoming more common in urgent care practice. Part 2 of this series offers step-by-step guidance on treatment of conditions from “tennis elbow” to bursitis and cysts. THOMAS V. GOCKE, III, MS, ATC, PA-C, DFAAPA The focus of Part 1 of this series, in the September issue of JUCM, was on understanding the inflammatory response, use of corticosteroids and anesthetic agents (Table 1), pre- and post-aspiration/injection considerations, …

Clinical Challenge: October, 2014

The Case This patient presented with a wrist injury. View the images taken (Figure 1) and consider what your diagnosis would be.

ST Elevation Myocardial Infarction

Urgent message: Chest pain in young adults is often benign but it’s important to always consider conditions that increase risk of cardiovascular disease when evaluating these patients. RAFAEL ILYAYEV, MD, FACP, MOHAMED A. MOHAMED, MD, AND HASSAN FARHAT, MD Overview This case illustrates the importance of considering and ruling out rare causes of coronary artery disease (CAD) in young patients who present with chest pain. One of these rare causes is a hypercoagulable state secondary …

Abstracts in Urgent Care: October, 2014

Timing of concussion symptoms Key point: Symptoms of concussion such as sleep disturbance, forgetfulness, and fatigue are late in onset. Citation: Eisenberg MA, Meehan WP 3rd, Mannix R. Duration and course of post-concussive symptoms. Pediatrics. 2014;133(6):999-1006. Estimates of the duration of concussion symptoms in children vary from 1 week to months. This study looks at previous cohorts where the median time to recovery was 13 days and considers symptoms, their duration, and clinical course. The …

Clinical Challenge: September, 2014

The Case This patient presented with a jammed thumb. View the images taken (Figure 1) and consider what your diagnosis would be.

Splenic Laceration

Urgent message: Visceral injury is possible in association with the seemingly minor trauma seen in urgent care, underscoring the importance of remaining alert for “red flag” signs and symptoms and judiciously using advanced diagnostics. Introduction Blunt abdominal trauma occurs in 10% to 15% of injured children.1 History and specifically mechanism of injury, and physical exam are important when a patient presents to the clinic with a suspected blunt abdominal trauma. Usually, injuries to the intra-abdominal …

An Urgent Care Approach to Joint and Soft-Tissue Injection/ Aspiration: Part 1

Urgent message: Injection/aspiration therapy for selected musculoskeletal complaints is becoming more common in urgent care practice. Providers need a thorough understanding of injection/aspiration procedures and associated risks to be equipped to deliver rescue therapy to patients. THOMAS V. GOCKE, III, MS, ATC, PA-C, DFAAPA Joint pain, joint effusion, and recurrent soft-tissue trigger point irritation are common presentations in urgent care. As more and more patients present seeking immediate relief of such symptoms, it’s important that …

Abstracts in Urgent Care – September 2014

Antibiotics and middle ear effusion Key point: Treatment with antibiotics seems to reduce the duration of middle ear effusion. Citation: Tapiainen T, Kujala T, Renko M, et al. Effect of antimicrobial treatment of acute otitis media on the daily disappearance of middle ear effusion: A placebo-controlled trial. JAMA Pediatr. 2014;168(7):635-641. Authors in this randomized, double blind, placebo-controlled trial compared 84 children aged 6 months to 15 years with acute otitis media who were either given …

Security Risk Assessment: Protecting Patients and Practice

Securing protected health information (PHI) is a goal we all share. Collectively, however, we are relatively clueless about how to achieve this, largely because of the massive amount of technology that almost all of us have adopted. A simple understanding begins with the most basic categorization of the technology that we use to store, transfer, and manage PHI: Software and hardware. Hardware includes all devices (desktops, laptops, routers, EKGs, and mobile devices) that store or …