News & Blogs

This week, we chat with Khang Gan and Erin Carn-Bennett from MedSim Solutions.

It is important to check for hyphaema, blood in the anterior chamber of the eye, after trauma. It is also important to use a slit lamp to check for microhyphaema

ANZAC day prompts us to reflect on the past.

How can we avoid errors associated with cognitive biases? In retrospect, we can easily see these biases unfold, but how can we identify them as they happen?

A tip to ensure you align the vermilion border accurately.

Do you use colchicine for acute gout flares? Are you aware of the risk factors for toxicity?

What is the knee to wall test and what does it measure?

Do you establish the patient agenda at each consultation?

An eponym named after the patient.

What conditions should we consider in hair professionals?

Seeing Bitot’s spots is pathognomic of vitamin A deficiency.

Professor James Reason was the originator of the Swiss Cheese model which has been an important model in developing ways to improve patient safety and reduce adverse events in healthcare.

What is a sentinel headache before a SAH and could they help us pick up earlier on a diagnosis in urgent care?

How long do grommets take to fall out?

You might think that neck pain after minor trauma is probably a musculoskeletal injury. But do not forget to consider vertebral artery dissection.

Look out for the Holstein-Lewis Fracture which is associated with radial nerve injury. Also, be aware of the torsional forces associated with arm wrestling.

It is important to check peripheral neurology after trauma. Neurapraxia, with an o, is one cause of altered sensation.

Are your patients aware that a fracture is the same as a break? Do they think that one is worse than the other?

Type 2 diabetics can present with a DKA associated with SGLT-2 inhibitors. And it may be euglycaemic. So be wary.

Pinworms are often asymptomatic, or cause mild pruritus ani, but do they cause abdominal pain?

If you are working in urgent care over the holiday period, thank you.

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.

We should be familiar with Reye Syndrome and its association with aspirin.

Do you palpate for the epitrochlear lymph node?

An interesting and thought-provoking TED talk that argues for the need for clinicians to continue to examine patients thoroughly.

Do you have a way to quickly and succinctly indicate that there is a possible patient of clinical concern within your clinic?

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.

While occurring in adolescents, Osgood-Schlatter Disease can persist into adulthood and is an important differential for anterior knee pain.

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.

What is the Koebner Phenomenon?

What should you look for in quadriceps tendon and patella tendon ruptures?

What is a Felon and what should we do about it?

Some important considerations when working up chest pain that will make us think of a thoracic aneurysm.

What is Kehr’s sign?

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.

Dry socket might present to urgent care. What is it and what should we do about it?

A caddy offers words of wisdom to their golfer. Some of their advice is relevant to urgent care.

We always look for the sail sign when reviewing radiographs of the elbow, but how often are they associated with occult fractures?

Cluster headaches present through urgent care and it is important to differentiate them correctly.

We need to be aware of medications with anticholinergic effects, especially in the elderly.

We need to be aware of medications with anticholinergic effects, especially in the elderly.

We need to be aware of medications with anticholinergic effects, especially in the elderly.

Weight-bearing at the time of the injury and assessment forms part of the Ottawa ankle rules.

Smell can be used to diagnose.

Do antihistamines help with the itch of dermatitis?

When you need help with identifying medications from overseas visitors, you can always call your local pharmacist, or you could try this website.

As medical professionals, we must know our legal and moral obligations to help in case of emergency.

Certain music can help improve your concentration, help you relax and improve your sleep.

Cold and flu remedies containing pseudoephedrine are now a class C drug in New Zealand and available from pharmacies.

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.

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.

Remember to consider an ASIS avulsion in young athletes who experience pain and a pop around their hip when sprinting.

A differential to consider when examining a dorsal wrist swelling.

Much like going to the gym, CPD can be a hassle or an imposition, but it can also be fun and hugely rewarding.

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.

What impact do your acute referral letters have on the admitting team?

We must be aware of the possibility of Cozen’s phenomenon in urgent care.

Today we hear of a case of Chopart injury presenting through urgent care. Thanks to Dr Antionio Castro.

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 forward.

Some common, non-psychotropic medications can have psychiatric side effects.

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.

Wellens’ Syndrome is an ECG finding indicative of critical LAD stenosis. Recognising this ECG change is vital.

We must counsel about the possibility of abnormal uterine bleeding starting, or worsening when commencing oral anticoagulation.

An interesting eponymous syndrome with a Kiwi connection.

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.

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.

When considering calcaneal fractures we must remember the Böhler angle and the angle of Gissane.

Do you know about the Corona Mortis?

Could caffeine withdrawal result in an urgent care visit?

An eponymous sign that helps in the diagnosis of glandular fever.

This week, the world’s best snooker players are competing for the Paul Hunter Trophy at the Masters in London. Paul sadly died of neuroendocrine tumours in 2006 whilst in his snooker prime.

Urgent Bite 201 – Thinking about referrals from UC

Jean Batten was a New Zealand pioneering aviatrix who died of empyema.

You might encounter an Ice Cream Headache over Christmas.

The 2024 Urgent Care Bootcamp conference will be held at the Rydges Hotel in Wellington on September 14th and 15th.

We should be reporting suspected medication-induced anaphylaxis to CARM. Likewise, remember to report cases of ACE-induced angioedema.

Words change but conditions stay the same.

Whether an incidental finding or related to a presenting issue, advising a surfer about preventing exostosis progression is important in urgent care.

Whether reviewing a possible subungual haematoma or an opportunistic finding, urgent care clinicians need to be aware of subungual melanoma.

We should always observe our patient’s gait and make sure to look our for a foot drop.

The Zurich Tongue Scheme may help you in assessing tongue lacerations in kids.

What would you think if a patient presents with a spontaneously bruised digit?

It is important to remember our role in recommending simple measures to help our patients and it is worth thinking about the power of take-home information that details the advice you have given.

Urinary alkalinisers can reduce the effectiveness of certain antibiotics

Dave has used this test for years to help with his diagnosis, so he was relieved to find a paper that supported its use.

Does colder air help ease croup?

Being burnt out can change the way we prescribe.

Smells can be nostalgic, but can they be antiemetic?

B12 deficiency is worth considering in some of the patients who present through UC.

Døds Diving, or death diving, is a Norwegian extreme sport. Watching it made me consider traumatic tympanic membrane ruptures

Palpating the cervical lymph nodes is a vital part of our examination of febrile kids.

Today we look back at 5 years of the Royal New Zealand College of Urgent Care podcasts.

A couple of eponymous signs to use in evaluating abdominal pain that helps determine a rectus sheath haematoma.

Look for the cardinal signs of Kawasaki disease in kids with persisting fever.

Elson’s test is an important test to know in urgent care.

High-pressure injection injuries might look innocuous on the surface, but they need an immediate surgical referral.

Bell’s palsy can be diagnosed clinically, but it is important to exclude other differentials.

Always look for Kanavel’s sign and refer if present.

Why should we look at the tongue in urgent care? And why does it sometimes stick out when we are thinking?

A tibial stress fracture in a golfer. Unusual, given that they are often associated with runners, but it does highlight how listening to your patient when they say something is wrong is important.

Today we chat with Dr David Sorrell about how he bends the needle to aid corneal foreign body removal.

A Latissimus Dorsi tear is a rare sporting injury but one we should be aware of in urgent care.

Will we need urgent care clinicians in an AI health system?

Cullen’s sign is an important eponym to recognise in urgent care.

Something a concerned parent might bring into urgent care.

We need to be aware of complex regional pain syndrome in urgent care.

Today we talk about a study into errors in primary care and ED with Dr Ivan Koay. We also discuss the Abstracts of Urgent Care that he curates at the JUCM and the importance of research in urgent care.

Cholesteatoma is an important diagnosis to consider in urgent care.

Pectoralis Major ruptures would seem to be an injury of the last 30 years and are related to bench pressing heavy weights.

It is worth refreshing your knowledge on local anaesthetic systemic toxicity.

Today we catch up with Dr David Sorrell, Director of Clinical Training, to discuss hand injuries.

The health literacy of our patients is an important consideration in urgent care.

What are the red flags when we see a patient with torticollis?

SUFEs will often first present in primary care and are easily missed.

Not everything that comes through UC is urgent, but knowing a little about these out-of-scope topics is still necessary.

Looking for and identifying a hypopyon is an important part of the UC eye exam.

We should all know how to do Seidel’s test in urgent care.

Good safety netting and follow-up are vital for patients presenting through UC with rectal bleeding.

As of February 1st, 2023, adrenaline auto-injectors are now funded in New Zealand under Special Authority.

Do you use Prednisone of Dexamethasone for croup?

Always look for a nasal septal haematoma in cases of nasal trauma.

Does expectation influence the experience of receiving an injection?

We should be cautious with penetrating volar hand lacerations.

A drug interaction that should be at the front of our minds.

We are joined by Dr Joshua Russell, Editor in Chief of the Journal of Urgent Care Medicine to talk about why we should be doing more vital sign re-checks in urgent care.

Urgent Care is for life, not just for Christmas

The rash of scarlet fever looks different, depending on skin colour.

It benefits our patients to remember to advise on whether they should remain nil by mouth on acute referral to hospital.

And conversely, a cup of tea can have beneficial treatment effects.

What is the ucipital mapillary?

Remember that increased activity can cause a venous thrombosis in the upper limb.

Make sure to look for the Fleck Sign

What actually is Rovsing sign and is it useful?

Is a Katz extractor an easier way to remove a nasal foreign body? And is it worth it?

For such a seemingly sedate and passive game played by old people, golf must be considered in a number of injuries.

A person had 23 contact lenses under their eyelid.

A few important things to remember about perichondritis of the pinna.

Watching the recent World Long Drive competition highlighted how sometimes a history can be misleading.

Dr Johanne Egan and Dr Charlotte Chambers spoke to us about burnout in urgent care at a webinar earlier this year. This podcast is the audio from that webinar.

Can a patient accurately locate a fish bone stuck in their throat? And are X-rays good at locating them?

We see it quite often but why is it called herpangina?

Important we consider potential interactions between opioids and antidepressants.

An important eponym that may help us miss fewer lunate dislocations on initial presentation.

An eponymous fracture that we tend not to hear used so much these days.

Let’s ask Dr Rob Evison how not to miss significant ankle injuries.

The Mason Classification helps us determine which radial head fractures need orthopaedic review.

Can you say the word quiet at work?

Be aware that there is potential for some shorthand notes to be read two ways.

When is a young person’s back ache not just a strain?

Weightlifters are at risk of triceps rupture. What should we look for in urgent care?

We must remember that kids can get Lisfranc injuries.

Come to our urgent care Bootcamp in Ōtautahi, Christchurch on September 17th and 18th 2022 at the Rydges, Latimer Square.

Dr Cole Rudolph, an Auckland GP, has launched a new website designed to collate CPD opportunities in one place for NZ clinicians.

We must always think to look for the Monteggia fracture.

Do you see haematospermia presenting through urgent care often?

We are joined by Dr Rory Miller to discuss a recently published paper that looked at the use of point of care troponin alongside an accelerated chest pain pathway in New Zealand rural and primary care.

Should you advise soaking the finger after nail trephination?

ACC has created some concussion educational material available through BPAC and the Goodfellow Unit.

Dr Jonathan Reisman is an ER physician, author and adventurer. He joins the podcast for a conversation about travel, medicine, adventure, food, anatomy and life, drawing on experiences he documents in his recently published book, The Unseen Body.

Find the Doctor NOS podcast here – https://doctornos.buzzsprout.com/

Find the Doctor NOS podcast here – https://doctornos.buzzsprout.com/

What factors can affect the reading you get from a glucometer?

Why is it called the tragus and when might we encounter it in urgent care?

We are joined by Dr Tim Funaki who talks to us about a recent experience he had when he discovered a guideline had changed without his realising. We discuss how we should feel comfortable looking up information, even if we think we already know it and we take a look at the Royal Children’s Hospital Melbourne infant reflux guidelines.

Have you heard of the Chauffeur Fracture?

Why do we have to do a yearly resus course?

We talk with Dr Jonathon Webber about a recent paper on which they were an author that looked at the variability in CPR training among NZ health professionals. We go on to discuss the benefits of a yearly CPR course and ways in which teams can get the most out of their yearly resus training

Dr Tamsin Lillie is a FRNZCUC currently in Malawi. We talk to her about her career in medicine, how she found Urgent Care and the charity work she is doing in Africa.

Why have I got swimmers ear, when I do not swim?

Torsion is a diagnosis not to miss. This is a good paper to review

In case you need some ideas for CPD, check out these ideas.

A good paper to read about antibiotic prescribing in children with LRTI and an opportunity to listen to the author of the paper

Professor Bruce Arroll tells us about his paper on the Emoqol 100 and how he uses it to screen for low mood.

Nostalgia used to be a medical condition.

Mastitis – with Dr Katie Fourie

Do you keep adequately hydrated during your shift? You should.

Read the paper – Hydration amongst nurses and doctors on call (the HANDS on prospective cohort study). El-Sharkawy A et al. Clin Nutr 2016 Aug;35(4):935-42 DOI: 10.1016/j.clnu.2015.07.007

Does a normal amylase/lipase rule out pancreatitis?

What is a BRUE?

Our fourth Urgent Care at Christmas discussion is inspired by a film that changed modern action thrillers and bucked the trend of action heroes being muscle-bound giants. Die Hard has long been considered a Christmas classic but the reason it has made our urgent care list is that it shows a common and very painful presentation to urgent care. The glass foreign body in the foot. To talk about the Welsh tradition of Mari Lwyd, singing carols, Alan Rickman and the pain of injecting the sole of the foot we are joined by Dr Zoë Cruse.

Our third Urgent Care at Christmas discussion is inspired by the blockbuster comic book movie, Iron Man 3. While it might not strike you as a classic Christmas movie, it does take place at Christmas and it highlights a condition that often presents to UC, especially over the holidays. To talk about the charm of English pubs, whether Love Actually still holds up and approaching insomnia through Urgent Care we are joined by UC Fellow Dr Caitlin Randles.

Our second Urgent Care at Christmas discussion is inspired by the 2003 modern classic Elf. To talk about a cold versus warm Christmas, demonstrate his Jimmy Stewart impression and discuss Raccoon bites, we are joined by Urgent Care Physician and Wilderness Medicine expert Dr Dinesh Deonarain.

For Christmas this year we have a short series of Urgent Care discussions inspired by some classic Christmas films. First up, the Snowman (1982). We talk with Dr David Sorrell about Christmas in urgent care and managing exhaust burns.

Dr Eva Gregory is an Auckland based doctor training in sexual health and general practice. They are a board member for Pride in Health, a charitable trust looking to support health care professionals in NZ to deliver excellent care to LGBTQIA+ patients.

Do you look stuff up during a consultation?

Why is it called the malleolus? It is interesting that what our patients might perceive as complicated medical words are actually just simple descriptive terms coined by ancient anatomists.

Dr Avijit Barai is a FACEM and FRNZCUC who has used POCUS in his daily practice for many years. He talks to us about the way he utilises POCUS and why he thinks it is an essential tool for all Emergency and Urgent Care physicians.

Measuring and improving outcomes is an important part of continuing professional development.

Some thoughts on how we make decisions to refer, observe or discharge, made through the lens of the aviation world. If you are interested, here is the YouTube video of the engine failure. https://www.youtube.com/watch?v=rEf35NtlBLg 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…

We chat with Dr David Sorrell, Director of Clinical Training about how he manages paronychia and we discuss the great learning points from a recent Don’t Forget the Bubbles video.

Have a read of this position paper on oral corticosteroid stewardship from the Thoracic Society of Australia and New Zealand.

Have a read of this position paper on oral corticosteroid stewardship from the Thoracic Society of Australia and New Zealand.

Have a read of this position paper on oral corticosteroid stewardship from the Thoracic Society of Australia and New Zealand.

We should all know to look for the de Winter T wave.

Welcome to Closing the Gap!

www.rnzcuc.org.nz

podcast@rnzcuc.org.nz

https://www.facebook.com/rnzcuc

Tweets by rnzcuc

Music licensed from www.premiumbeat.com

Full Grip by Score Squad

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 times. For personal medical advice always consult your usual doctor

Here is a good website that features many talks and presentations on all things orthopaedic.

Check out the website – https://orthomedia.org.uk/

A nasty ankle fracture named after a bit of kitchen equipment.

Even if you think you know something, it is always worth refreshing your knowledge.

Today we update our College members on the move to a virtual Bootcamp and the rollout of the new recertification programme.

Today, Dr Avijit Barai talks to us about sternoclavicular joint injuries.