Case A 67-year-old male presents with acute mid-low back pain following a fall. He describes the pain as “dull and constant.” When asked if the pain is worse with range of motion, he replies, “I think so.” Physical exam reveals he is afebrile, has a pulse of 102, respirations 20, and blood pressure 122/78. His abdomen is soft and nontender without rigidity, rebound, or guarding; there is no bruising or distention. His back appears normal, though there is mild discomfort with deep palpation in the right low back musculature. TheRead More
Urgent message: Acute compartment syndrome (ACS) is an important high-risk diagnosis to exclude when evaluating peripheral extremity injury. Providers must maintain a high clinical index of suspicion with careful attention to the history and mechanics of injury in an urgent care setting to preclude the devastating, rapidly developing sequela of ACS. Missing a case of ACS may result in significant morbidity—and even mortality. Awareness of both subtle and overt signs will ensure the best care of the urgent care patient. There are multiple case reports throughout the literature detailing theRead More
Urgent message: This is a really big deal to urgent care clinicians and operators. Introduction Achilles tendon (AT) ruptures account for approximately 40% of all operative tendon repairs.1,2 With 18 ruptures per 100,000 people, it is the most frequently ruptured tendon—and the incidence of AT ruptures has been steadily increasing over the past few decades.1–4 Typical patients include athletic males between the ages of 30 and 50.3 Because the AT is the strongest, yet most frequently ruptured tendon in the body, the pathophysiology of these ruptures has been studied atRead More

Posted On March 27, 2017 By In Abstracts

Abstracts in Urgent Care – April 2017

Lessons from Recent Terrorist Attacks Key point: Investment, integration, standardization, and focus on translating military knowledge. Citation: Goralnick E, Van Trimpont F, Carli P. Preparing for the next terrorism attack: lessons from Paris, Brussels, and Boston. JAMA Surg. 2017 Jan 25. [Epub ahead of print] This viewpoint article in JAMA Surgery sheds light on the need for a more global concerted effort to gather and share lessons from recent terrorist attacks such as those that occurred in Nice, Paris, Orlando, and Istanbul. The authors propose that the valuable lessons learnedRead More
Patient satisfaction surveys have driven a contentious wedge between management and clinical teams. While management is tasked with ensuring the practice is addressing patient needs and evolving consumer demands, providers are far more concerned with doing the right thing clinically (satisfaction be damned). However, with patient expectations changing, access to care improving, and practice economics eroding, we have to find a way to bridge this issue or we will quickly find ourselves locked in counterproductive bickering while others run off with our patients. Remember, the aging urgent care value propositionRead More
It’s tax time again and that got me thinking. And thinking got me angry. And angry got me belligerent. And belligerent got me nowhere. So, I went back to thinking about it, and here’s my take: Taxes are the contributions we make to society and the government so that it functions reasonably well, preserves our fragile democracy, and supports those who need our help. Yet, as a physician in a primary care specialty, like many of you, I can’t help but feel resentful this time of year. I’m “taxed out,”Read More

Posted On March 1, 2017 By In Abstracts

Abstracts in Urgent Care March 2017

Clindamycin Reduces Resistance to Group A Strep Key point: Another use for clindamycin. Citation: Andreoni F, Zurcher C, Tamutzer A, et al. Clindamycin affects group A streptococcus virulence factors and improves clinical outcome. J Infect Dis. 2017;215(2):269-277. Necrotizing fasciitis is a life-threatening infection not frequently seen in the urgent care center, though it does occur. This article from the Infectious Diseases Society of America discusses the importance of adding clindamycin to the treatment regimen. No good quality evidence was present before this article proving the effect, but it was surmisedRead More
Urgent message: While pediatric elbow injuries can be a simple fix in an urgent care setting, understanding mechanism of injury and recognizing cases where referral is warranted help ensure positive outcomes. Pediatric musculoskeletal injuries comprise approximately 12% of the 10 million annual visits to urgent care centers and emergency departments in the United States. History, physical exam and proper imaging remain the mainstay of diagnosis and treatment of many orthopedic related chief complaints. The purpose of this article is to provide a simple and concise approach to evaluation of commonRead More