The patient, an otherwise healthy 25-year-old, fell and suffered a blow to the right hip. The injury was not weight-bearing. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is described on the next page.
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High-Risk Conditions Presenting as Back Pain
Urgent message: That back pain is common and typically without serious sequelae may result in misdiagnosis and mistreatment. ERICA MARSHBURN, BS, BA, AND JOHN SHUFELDT, MD, JD, MBA, FACEP Many high-risk conditions can present as back pain, is a very frequent presenting complaint in urgent care medicine. Most back pain is muscular in origin and responds well to conservative intervention. However, because of the frequency of the complaint and infrequency of serious sequelae, providers may …
Read MoreCLINICAL CHALLENGE: CASE 2
The patient, an otherwise healthy 64-year-old, fell, suffered a blow to the shoulder, and presents with clinical dislocation. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is described on the next page.
Read MoreClinical Challenge: December, 2011
In each issue, JUCM will challenge your diagnostic acumen with a glimpse of x-rays, electrocardiograms, and photographs of dermatologic conditions that real urgent care patients have presented with. If you would like to submit a case for consideration, please email the relevant materials and presenting information to [email protected]. The patient, an otherwise healthy 2-year-old, had a history of playing with button batteries and then started crying with discomfort on the left side of the nose. …
Read MoreAbstracts in Urgent Care: December, 2011
NAHUM KOVALSKI, BSc, MDCM Effect of Adrenaline on Survival in Out-of-hospital Cardiac Arrest Key point: Adrenaline improves chance of return of spontaneous circulation but not survival to discharge. Citation: Jacobs IG, Finn JC, Jelinek GA, et al. Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomized double-blind placebo-controlled trial. Resuscitation. 2011;82(9):1138-1143. Adrenaline has been used to treat patients with cardiac arrest for more than half a century but has not been evaluated in …
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A Painful Swollen Joint in an Elderly Male
Urgent message: The patient had two recent bee stings. Did they cause his problem or were they red herrings? PAUL BURES, DO, and LEE A. RESNICK, MD Introduction Hot, swollen, tender joints are a common initial complaint in the urgent care setting. Depending on the patient’s HPI and PMH, a definitive diagnosis can often be concluded. A systematic evaluation of infectious, inflammatory, and traumatic causes can help narrow the differential. Judicious use of the laboratory …
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Altered Mental Status in the Urgent Care Patient
Urgent message: As the population of seniors swells, more cases of senile dementia, delirium, and psychosis are apt to present in urgent care. Here is how to assess and manage these patients. RAUL E. RODON, MD Introduction Evaluating patients presenting with altered mental status in the urgent care setting requires a modified skill set, one that varies from the assessment of patients with a similar profile in a hospital emergency department. Limited access to standard …
Read MoreReforming Healthcare Starts With Reforming Patient Expectations
Back in 2008, while the Obama administration was first evaluating healthcare reform, Peter Orszag, then the director of the Congressional Budget Office, estimated that 5% of the nation’s gross domestic product, or $700 billion per year, goes to medical tests and procedures that have no proven positive impact on outcomes. Unaccounted for in this estimate are the billions more spent managing the often lifelong complications inherited from inappropriate tests and unproven procedures. MRIs that identify …
Read MoreAbstracts in Urgent Care: November, 2011
Chinese Herbs Are as Efficient as Oseltamivir for Shortening Flu Symptoms Key point: Traditional Chinese herbal therapy resolves fever in influenza as quickly as oseltamivir. Citation: Wang C, Cao B, Liu Q-Q, et al. Oseltamivir compared with the Chinese traditional therapy maxingshigan-yinqiaosan in the treatment of H1N1 influenza: a randomized trial. Ann Int Med. 2011;155(4):217-225. Researchers studied some 400 adults and adolescents in 11 Chinese hospitals who had uncomplicated 2009 H1N1 influenza A. Patients, who …
Read MoreClinical Challenge: November, 2011
The patient, an otherwise healthy 45-year-old, has had a cough for a month. Location: left side of the chest. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is described on the next page.
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