A 38-Year-Old Man with Chest Pain

A 38-Year-Old Man with Chest Pain

Urgent message: When a relatively young patient presents to urgent care with chest pain, there may or may not be a “typical” cause. Prompt evaluation and accurate assessment of risk factors are essential to efficient care and, often, the patient’s survival. Max Palatnik, MD Case Presentation A 35-year-old male presented at 21:59 with a chief complaint of chest pain; at 22:03, we noted the following: Temp: 98.9 Pulse: 103 Resp: 16 Syst: 122 Diast: 69 …

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A 73-Year-Old Man with a 2-Week History of Palpitations

A 73-Year-Old Man with a 2-Week History of Palpitations

Case The patient is a 73-year-old male smoker who complains that he has had intermittent palpitations for the past 2 weeks. He denies chest pain, diaphoresis, fever, or dizziness. He uses home oxygen, 2 L/min, but denies any new shortness of breath. Upon exam, you find: General: Alert and oriented x 3 Lungs: Scattered minimal wheezing, which is symmetric Cardiovascular: Regular and tachycardic without murmur, rub, or gallop Abdomen: Soft and nontender without rigidity, rebound, …

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Young Football Player with Sudden Chest Pain

Case A 20-year-old previously healthy man presents with sudden onset of substernal chest pressure after completing football practice. His chest pain is nonradiating, nonreproducible, and nonpositional. He does not have associated palpitations, dyspnea, or diaphoresis. He reports that he has not had recent upper respiratory tract infections or contact with ill people. He does not have a history of using alcohol, tobacco, or illicit drugs. He has no family history of sudden cardiac death or …

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Ten-Day Dry Cough in a 36-Year-Old Man

Case A 36-year-old man presents to an urgent care center with a dry cough that he has had for the preceding 10 days. He has mild dyspnea. He has no rhinorrhea, fever, chest pain, blood in the urine or stool, or lower-extremity pain or swelling. He has no history of previous illnesses. He smokes cigarettes, occasionally drinks alcohol, and has a remote history of intravenous drug use. View the image taken (Figure 1) and consider …

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Clavicular Pain in a 23-Year-Old

Case A 23-year-old man presents to an urgent care with pain at the distal end of his left clavicle that began the previous day after he fell onto his left shoulder while mountain biking. His pain is constant and sharp and worse when moving his left arm and shoulder. He does not have fever, vomiting, chest pain, shortness of breath, or abdominal pain, and he has no head injury, no head or neck pain, and …

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Evaluating Chest Pain in Urgent Care— “Catch 22 and the Three Bears”: Part 2

Lee A. Resnick, MD, FAAFP In my last column, I introduced a framework for evaluating chest pain in urgent care. In this month’s column I discuss a risk and probability stratification that can assist in disposition decision-making. The following discussion considers existing evidence, but there is no formal guideline for this process in the outpatient setting. Our goal is to make a risky scenario into something we can live with. This model is for risk-stratification …

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Evaluating Chest Pain in Urgent Care— “Catch 22 and the Three Bears”: Part 1

Lee A. Resnick, MD, FAAFP What can Joseph Heller and Goldilocks teach us about managing no-win situations in urgent care? As it turns out, if you look under the covers of Baby Bear’s bed, you might find something meaningful, perhaps even something that’s “just right.” Take the classic no-win situation when patients present to urgent care with chest pain. Without a definitive and reliable test to guide our decision making, we are stuck with the …

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Chest Pain, Bradycardia, and ECG Changes in Acute Cholecystitis

Chest Pain, Bradycardia, and ECG Changes in Acute Cholecystitis

Urgent message: Urgent care clinicians should consider the possibility of cholecystitis when evaluating patients with cardiac symptoms. A delay in diagnosis may lead to serious complications, including sepsis. ALONA D. ANGOSTA, PhD, APRN, NP-C, and BRYAN HOLMES, NREMTP Introduction Patients with acute cholecystitis typically complain of right-upper-quadrant pain that radiates to the right shoulder and back, fever, and leukocytosis.1 The pain may also be associated with nausea or vomiting. However, acute cholecystitis can mimic cardiac …

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Abstracts in Urgent Care: December, 2013

Long-term survival following pneumococcal pneumonia Key point: Pneumococcal pneumonia foretold considerably higher  10-year  mortality  than the expected rate. Citation: Sandvall B, Rueda AM, Musher DM. Long-term sur- vival following pneumococcal pneumonia. Clin Infect Dis. 2013;56(8):1145-1146. Before antibiotics, pneumonia was called “the old man’s friend” for carrying the old and infirm to a swift and relatively painless death. Now that short-term survival after pneumonia is the rule, does the disease provide any long-term prognostic information? Veterans …

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