Journal of Urgent Care Medicine

Evaluation of Knee Pain: An Urgent Care Approach

Urgent message: Knee pain is a diagnostic challenge for urgent care providers, but a strong understanding of the anatomy and potential etiologies will prepare them for success. CHRISTOPHER TANGEN, DO Approximately 10% of all urgent care visits are for musculoskeletal complaints and knee pain is a common such presentation. An urgent care provider’s approach is different than that of specialists because patients present with more acute cases, and therefore, the physician needs to consider a …

Dare We Doubt the Wisdom of Patient Empowerment?

Lee A. Resnick, MD, FAAFP “Patient empowerment,” “patient-centered care, “patient-focused care,” and “shared medical decision-making” are among a growing number of terms intended to shift the power and control of healthcare decisions from physicians to patients. The concepts are, for all intents and purposes, accepted as “good.” It is merely assumed that empowered patients are better off than those who defer control of their healthcare decisions to their clinicians. Despite an almost revolutionary change in …

Abstracts in Urgent Care: June, 2006

Azithromycin: FDA Issues Cardiac Warning Key point: The antibiotic azithromycin (Zithromax and Zmax) can cause QT interval prolongation and torsades de pointes. Citation: FDA Drug Safety Communication: Azithromycin (Zithromax or Zmax) and the risk of potentially fatal heart rhythms. http://www.fda.gov/downloads/Drugs/DrugSafety/ UCM343347.pdf The agency says that healthcare providers should consider risk of fatal heart rhythms when treating patients already at high cardiovascular risk, including people with known prolon- gation of the QT interval, torsades de pointes, …

Clinical Challenge: June, 2013

The patient, a 4-year-old boy, tripped and twisted his right ankle. He was not able to bear weight on his right foot. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is described on the next page.

Rhabdomyolysis

Urgent message: For patients with flu-like symptoms, a careful history and examination are important to rule out more threatening diagnoses. SHRINESH V. PATEL, MD Overview In late winter/early spring, urgent care providers often encounter patients with flu or flu-like illnesses. It is easy to assume that an individual with a typical pattern of flu-like symptoms has the flu and not consider other pathologic processes.However, alternative diagnoses should always be in the differential, and careful history, …

Abstracts in Urgent Care: May, 2013

Ondansetron Safe During Pregnancy Key point: No significant association between the antiemetic on- dansetron and adverse pregnancy outcomes. Citation: Pasternak B, Svanstrom H, Hviid A. Ondansetron in pregnancy and risk of adverse fetal outcomes. N Engl J Med 2013;368:814-823. In this retrospective cohort study, ondansetron had been prescribed for nausea and vomiting in almost 2000 of some 600,000 pregnancies. Ondansetron users were no more likely than nonusers to experience spontaneous abortion or stillbirth, or to …

Clinical Challenge: May, 2013

The patient, a 22-year-old woman, presented with a complaint of chest pain. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is described on the next page.

A Slowly Healing Leg Wound

Urgent message: Clinical suspicion of CA-MRSA should be high for any skin wound or soft tissue infection with delayed healing, abscess, or persistent cellulitis. RALPH S. BOVARD, MD, MPH, and ANNE REINER, MD, MPH Introduction Caregivers need to remain vigilant and challenge diagnoses to avoid complacency in the treatment of “common” problems. We all need to foster the habit of systematic and meticulous clinical evaluation. As Goethe said: “We see what we know.” Case Presentation …

The ED Utilization Debate: Can a Shell-Game Redirect the Scrutiny?

Lee A. Resnick, MD, FAAFP You might not expect one of our most prestigious medical journals to be susceptible to scientific sleight of hand. But the JAMAeditorial board apparently fell victim to just that in publishing the latest in a string of self-serving, extraordinarily biased “studies” supported by the American College of Emergency Physicians (ACEP), entitled “Comparison of Presenting Complaint vs Discharge Diagnosis for Identifying “Nonemergency” Emergency Department Visits.” The study’s objective was to determine …

An Urgent Care Approach to Low Back Pain

Urgent message: To better evaluate and treat patients with low back pain, urgent care providers need a good understanding of the anatomy of the back and they must be vigilant for “red flags” that signal a potentially serious condition. SHAILENDRA K. SAXENA, MD, PHD, MIKAYLA SPANGLER, PHARM D, BCPS, and SANJEEV K. SHARMA, MD, MBA Introduction Acute low back pain is a common condition often seen by urgent care providers. An episode of acute low …

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