Patients uncommonly present to urgent care clinics with ischemic cardiac symptoms, but these situations do occur and represent a high risk to both clinician and patient. All clinicians should be aware of any ECG findings which may predict potential cardiac risk. Wellens’ sign is one ECG pattern which, when present, is highly specific for significant coronary heart disease, even in patients whose symptoms have resolved by the time the ECG is performed. This article will present a specific patient case and review the pertinent ECG findings of Wellens’ syndrome.
Guidelines recommend 12-lead ECG as an important test to perform in patients with syncope. Though the incidence of ECG abnormalities is quite low, urgent care clinicians must be knowledgeable about the findings which portend the high est risk for these patients. Having a structured approach to interpreting these patients’ ECGs, and acting appropriately when abnormalities are found, should minimize morbidity and mortality in this patient group.
Pulmonary embolism is reported to occur in 8% to 27% of patients in ICUs (1, 2). A predisposing risk factor can be identified in the majority of these critically ill patients. Common risk factors include prolonged immobility, congestive heart failure, neoplastic disease, and hypercoagulable states (3). Despite this high frequency of venous thromboembolism (VTE.). autopsy studies (4) suggest that the diagnosis is not made antemortem in the majority of cases. We describe a previously healthy individual who developed a pulmonary embolism secondary to a barbiturate overdose and temporary immobility, a previously unreported diathesis.
Urinary tract infections are commonly treated in urgent care practice. Clinicians need to be aware of the advantages and limitations of diagnostic tests, as well as the proper empiric antibiotic treatment of these infections, in order to effect the best outcomes for patients. Several recent articles and a published guideline provide the most up-to-date information and form the basis of this review.
You start your shift. An elderly woman with shortness of breath has congestive heart failure written all over her and her chart. She takes beta-blockers, an ACE inhibitor, and Lasix®. She looks and sounds “wet.” She receives oxygen, furosemide, morphine, and nitrate therapy. When you return 20 minut
