Type 2 diabetics can present with a DKA associated with SGLT-2 inhibitors. And it may be euglycaemic. So be wary. Check out the Prescriber Update, Vol 45, No 4, Dec 2024 Check out the Stat Pearls page on DKA Lizzo JM, Goyal A, Gupta V. Adult Diabetic Ketoacidosis. [Updated 2023 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Pu…

Pinworms are often asymptomatic, or cause mild pruritus ani, but do they cause abdominal pain? Check out the pages mentioned. Demnet page on pinworms by Daniel Wong Enterobius vermicularis: a possible cause of symptoms resembling appendicitis Dahlstrom, J.Macarthur, E. et al. Pathology, Volume 25, 5 Link to paper Panidis S, Paramythiotis D, Panagio…

If you are working in urgent care over the holiday period, thank you. www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals. Please ensure you work within your scope of practice at all t…

While the Christmas period is supposed to be a happy holiday for all, there are many increased stressors at this time of year. These papers give food for thought for the season. Mohammad MA, Karlsson S, Haddad J, Cederberg B, Jernberg T, Lindahl B, Fröbert O, Koul S, Erlinge D. Christmas, national holidays, sport events, and time factors as trigger…

We should be familiar with Reye Syndrome and its association with aspirin. Check out the Stat Pearls page Chapman J, Arnold JK. Reye Syndrome. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526101/ Check out the original Reye paper REYE R…

Do you palpate for the epitrochlear lymph node? Check out the papers mentioned Selby CD, Marcus HS, Toghill PJ. Enlarged epitrochlear lymph nodes: an old physical sign revisited. J R Coll Physicians Lond. 1992 Apr;26(2):159-61. PMID: 1588523; PMCID: PMC5375540. https://pmc.ncbi.nlm.nih.gov/articles/PMC5375540/ Catalano O, Nunziata A, Saturnino PP, …

An interesting and thought-provoking TED talk that argues for the need for clinicians to continue to examine patients thoroughly. Check out Dr Verghese's TED talk here. www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc Music licensed from www.premiumbeat.com Full Grip by Score Squad This podcast is i…

Do you have a way to quickly and succinctly indicate that there is a possible patient of clinical concern within your clinic? Read about Pan-pan on Wikipedia. www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc Music licensed from www.premiumbeat.com Full Grip by Score Squad This podcast is intended to…

This week we talk with Dr Lindsey Fish, Medical Director of the Peña Southwest Urgent Care Clinic at the Denver Health and Hospital. She is an Associate Professor of Medicine at the University of Colorado School of Medicine. She was one of the authors of a paper published in the Journal of Urgent Care Medicine that showed patients discharged from u…

While occurring in adolescents, Osgood-Schlatter Disease can persist into adulthood and is an important differential for anterior knee pain. Check out the OrthoBullets page by Dr Woon Check out the Radiopaedia page by Hererra Check out the Case Report Mentioned Murphy CE, Kenny CM. Not just for boys: a rare case of symptomatic Osgood-Schlatter dise…

Dr Joshua Russell, Editor in Chief of the Journal of Urgent Care Medicine came to New Zealand from the USA for our Bootcamp in Wellington. Here we discuss his thoughts on NZ, UC down under, the future of Urgent Care and why UC research is so important. Details on the JUCM Fellowship in Medical Writing can be found here. Check out the Bootcamp repor…

What is the Koebner Phenomenon? Check out the Dermnet pages mentioned. Tattoo-associated skin reactions by Ngan and Elghblawi Koebner Phenomenon by Luo www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc Music licensed from www.premiumbeat.com Full Grip by Score Squad This podcast is intended to assist…

What should you look for in quadriceps tendon and patella tendon ruptures? Check out the Orthobullets pages Patella Tendon by Ben Sharareh MD - https://www.orthobullets.com/knee-and-sports/3024/patellar-tendon-rupture Quadriceps Tenson by Jason McKean MD - https://www.orthobullets.com/knee-and-sports/3023/quadriceps-tendon-rupture Check out the vid…

What is a Felon and what should we do about it? Check out the papers and pages mentioned. Nardi NM, McDonald EJ, Syed HA, et al. Felon. [Updated 2024 Apr 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430933/ Orthobullets page by Leah Ahn MD Koshy JC, Bel…

Some important considerations when working up chest pain that will make us think of a thoracic aneurysm. Check out the paper mentioned Habib M, Lindström D, Lilly JB, D'Oria M, Wanhainen A, Khashram M, Dean A, Mani K. Descending thoracic aortic emergencies: Past, present, and future. Semin Vasc Surg. 2023 Jun;36(2):139-149. doi: 10.1053/j.semvascsu…

What is Kehr's sign? Check out the paper mentioned Rastogi V, Singh D, Tekiner H, Ye F, Mazza JJ, Yale SH. Abdominal Physical Signs of Inspection and Medical Eponyms. Clin Med Res. 2019 Dec;17(3-4):115-126. doi: 10.3121/cmr.2019.1420. Epub 2019 Jul 15. PMID: 31308022; PMCID: PMC6886890. www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.c…

Drug-induced tendinopathy can occur early, and late in a person's usage. So we must consider a patient's medication history closely whenever they have symptoms of tendinopathy or rupture. Check out the September 2024 Prescriber update, Vol 5, No 3. www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc Mu…

Dry socket might present to urgent care. What is it and what should we do about it? Check out the papers mentioned Chemaly D. How do I manage a patient with dry socket? J Can Dent Assoc. 2013;79:d54. PMID: 23763736. https://pubmed.ncbi.nlm.nih.gov/23763736/ Mamoun J. Dry Socket Etiology, Diagnosis, and Clinical Treatment Techniques. J Korean Assoc …

A caddy offers words of wisdom to their golfer. Some of their advice is relevant to urgent care. Check out the paper mentioned Gotlieb R, Praska C, Hendrickson MA, Marmet J, Charpentier V, Hause E, Allen KA, Lunos S, Pitt MB. Accuracy in Patient Understanding of Common Medical Phrases. JAMA Netw Open. 2022 Nov 1;5(11):e2242972. doi: 10.1001/jamanet…

We always look for the sail sign when reviewing radiographs of the elbow, but how often are they associated with occult fractures? Check out the papers mentioned Skaggs DL, Mirzayan R. The posterior fat pad sign in association with occult fracture of the elbow in children. J Bone Joint Surg Am. 1999 Oct;81(10):1429-33. doi: 10.2106/00004623-1999100…

Cluster headaches present through urgent care and it is important to differentiate them correctly. Check out the paper on which Lisa Kudrow has a credit Messinger HB, Messinger MI, Kudrow L, Kudrow LV. Handedness and headache. Cephalalgia. 1994 Feb;14(1):64-7. doi: 10.1046/j.1468-2982.1994.1401064.x. PMID: 8200028. Check out the paper mentioned Wea…

Don't confuse the Popeye Sign with the reverse Popeye Sign. Check out the Stat Pearls Page - Hsu D, Anand P, Mabrouk A, et al. Biceps Tendon Rupture. [Updated 2023 Jul 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Check out the OrthoBullets Page on distal ruptures. Get Bootcamp tickets here - https://rnzcuc…

When do you perform a chest X-ray for chest trauma presenting through urgent care? This week we chat about this, and the STUMBL score, with Director of Clinical Training Dr David Sorrell. Check out the STUMBL score on MD Calc - https://www.mdcalc.com/calc/10468/stumbl-battle-score Check out the paper mentioned by Dave Galvez, Carlos, Arenas-Jimenez…

We need to be aware of medications with anticholinergic effects, especially in the elderly. Check out the BPAC article mentioned - https://bpac.org.nz/2024/anticholinergic.aspx#tab1 Check out the ACB calculator by Dr Rebecca King and Steve Rabino - https://www.acbcalc.com/ www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc http…

Weight-bearing at the time of the injury and assessment forms part of the Ottawa ankle rules. Check out the paper mentioned Chien B, Hofmann K, Ghorbanhoseini M, Zurakowski D, Rodriguez EK, Appleton P, Ellington JK, Kwon JY. Relationship of Self-Reported Ability to Weight-Bear Immediately After Injury as Predictor of Stability for Ankle Fractures. …

Smell can be used to diagnose. Check out the paper mentioned Trivedi DK, Sinclair E, Xu Y, Sarkar D, Walton-Doyle C, Liscio C, Banks P, Milne J, Silverdale M, Kunath T, Goodacre R, Barran P. Discovery of Volatile Biomarkers of Parkinson's Disease from Sebum. ACS Cent Sci. 2019 Apr 24;5(4):599-606. doi: 10.1021/acscentsci.8b00879. Epub 2019 Mar 20. …

Do antihistamines help with the itch of dermatitis? Check out the paper mentioned Nankervis H, Thomas KS, Delamere FM, Barbarot S, Rogers NK, Williams HC. Scoping systematic review of treatments for eczema. Southampton (UK): NIHR Journals Library; 2016 May. PMID: 27280278. Check out the Dermnet NZ page. Authors: Dr Amy Stanway, Department of Dermat…

When you need help with identifying medications from overseas visitors, you can always call your local pharmacist, or you could try this website. Check out the webpage mentioned - https://www.resourcepharm.com/pharmacist/identification-of-foreign-medicines.html www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.…

As medical professionals, we must know our legal and moral obligations to help in case of emergency. Check out the MCNZ page on helping in an emergency. www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc Music licensed from www.premiumbeat.com Full Grip by Score Squad This podcast is intended to assis…

Certain music can help improve your concentration, help you relax and improve your sleep. Check out https://www.brain.fm/ Check out their white paper. www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc Music licensed from www.premiumbeat.com Full Grip by Score Squad This podcast is intended to assist …

Cold and flu remedies containing pseudoephedrine are now a class C drug in New Zealand and available from pharmacies. Check out the prescriber update from June 2024. Check out the Ministry of Health page. www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc Music licensed from www.premiumbeat.com Full G…

Dr Tony Smith, Deputy Clinical Director at Hato Hone St John, tells us about Double Sequential and Vector Change Defibrillation for resistant VF/VT. These new techniques, not currently covered in our NZRC resus algorithms, are being utilised by all ambulance services in New Zealand for patients who do not get ROSC after three shocks. Tony can be co…

Professor Bruce Arroll talks to us about a practical technique that can help regulate breathing in people having panic attacks or during an asthma attack. The conversation then leads into discussing the Polyvagal Theory, physician wellness, and chronic pain. Check out the Goodfellow unit resources. The Gem mentioned The Polyvagal Theory webinar The…

Remember to consider an ASIS avulsion in young athletes who experience pain and a pop around their hip when sprinting. Check out the Orthobullets page https://www.orthobullets.com/knee-and-sports/3091/anterior-superior-iliac-spine-asis-avulsion www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc Music …

A differential to consider when examining a dorsal wrist swelling. Check out the Radiopaedia pages On Ganglion cysts On Carpal Boss www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc Music licensed from www.premiumbeat.com Full Grip by Score Squad This podcast is intended to assist in ongoing medical …

Much like going to the gym, CPD can be a hassle or an imposition, but it can also be fun and hugely rewarding. Check out the paper mentioned Jeong D, Presseau J, ElChamaa R, Naumann DN, Mascaro C, Luconi F, Smith KM, Kitto S. Barriers and Facilitators to Self-Directed Learning in Continuing Professional Development for Physicians in Canada: A Scopi…

Should we be listening for bowel sounds? Despite evidence suggesting they are not useful, I still think it is an important part of an urgent care assessment. Check out the papers mentioned. Elhardello O, Macfie J. Bowel Sounds: Is it Time for Surgeons to Hang-up their Stethoscopes?. World J Surg Surgical Res. 2018; 1: 1066. Link to paper. Breum BM,…

What impact do your acute referral letters have on the admitting team? You may have noticed the initial upload contained the wrong audio file of an old podcast. Sorry, this has been corrected. Check out the papers mentioned Chauveau P, Mazet-Guillaume B, Baron C, Roy PM, Tanguy M, Fanello S. Impact du contenu du courrier médical sur la qualité du t…

We must be aware of the possibility of Cozen's phenomenon in urgent care. Check out the Radiopedia page by Tim Luijkx https://radiopaedia.org/articles/cozen-fracture-1 Check out the Orthobullets page by Macknett MD et al https://www.orthobullets.com/pediatrics/4025/proximal-tibia-metaphyseal-fractures--pediatric Check out the obituary of Dr Lewis C…

Today we hear of a case of Chopart injury presenting through urgent care. Thanks to Dr Antonio Castro. Check out the paper mentioned Metcalfe TSN, Aamir J, Mason LW. Chopart dislocations: a review of diagnosis, treatment and outcomes. Arch Orthop Trauma Surg. 2024 Jan;144(1):131-147. doi: 10.1007/s00402-023-05040-4. Epub 2023 Sep 15. PMID: 37715068…

2 years ago we spoke with Dr Tamsin Lillie, a Fellow of the RNZCUC who runs a medical charity that helps fund African students through medical training. Last time we spoke she was calling in from Malawi, but a chance meeting in person prompted a quick catch-up about what has been going on over the last 2 years and her hopes for the charity moving f…

Some common, non-psychotropic medications can have psychiatric side effects. Check out the article mentioned Prescriber Update 45(1): 5-8 March 2024 https://www.medsafe.govt.nz/profs/PUArticles/March2024/Unexplained-mood-and-behavioural-changes.html www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc M…

Hoffmann's sign is a simple test that can help in diagnosing cervical myelopathy and upper motor neurone disease as part of a thorough history and examination. Check out the paper mentioned Nemani VM, Kim HJ, Piyaskulkaew C, Nguyen JT, Riew KD. Correlation of cord signal change with physical examination findings in patients with cervical myelopathy…

Wellens' Syndrome is an ECG finding indicative of critical LAD stenosis. Recognising this ECG change is vital. Check out the Life in the Fast Lane post by Dr Mike Cadogan and Dr Robert Buttner from September 2021 https://litfl.com/wellens-syndrome-ecg-library/ This is a BMJ case report that is worth reading. Ramires TG, Sant'Anna J, Pais J, Picarra…

We must counsel about the possibility of abnormal uterine bleeding starting, or worsening when commencing oral anticoagulation. Check out the Prescriber update - December 2023 edition - https://www.medsafe.govt.nz/profs/PUArticles/PDF/Prescriber-Update-44-No.4-December-2023.pdf Check out the paper mentioned de Jong CMM, Blondon M, Ay C, Buchmuller …

An interesting eponymous syndrome with a Kiwi connection. Check out the Stat Pearls Page Tafti D, Cecava ND. Poland Syndrome. [Updated 2023 May 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532259/ https://www.ncbi.nlm.nih.gov/books/NBK532259/ Read more …

In cases of ongoing post-prandial epigastric pain and sitophobia despite endoscopy work up and treatment perhaps we should remember to recall Dunbar Syndrome to our differential list. Check out the paper mentioned Li J, Tan XY, Megahed A, Evangelista A. Dunbar syndrome: An unusual cause of chronic postprandial abdominal pain. Radiol Case Rep. 2020 …

Grover disease might present through your urgent care. While not a critical or life-threatening condition, recognising it so we can advise and support your patient is important. To help us consider differentials for various presenting complaints there is a useful website you can use. Check out the Cunneliffe (TP) General Dermatology Diagnostic Tool…

When considering calcaneal fractures we must remember the Böhler angle and the angle of Gissane. Check out the Orthobullets page written by Crag Forsthoefel MD. https://www.orthobullets.com/trauma/1051/calcaneus-fractures Check out the Radiopaedia articles Benoudina S, Worsley C, Knipe H, et al. Gissane angle. Reference article, Radiopaedia.org (Ac…

Do you know about the Corona Mortis? Today with chat to Dr Tim Brabants who has seen a case and feels we should be aware of its potential in urgent care. Tim is a UK-trained doctor who has worked in the UK and South Africa, predominantly in emergency medicine. Now based in New Zealand, he is a senior Registrar with the RNZCUC Check out these resour…