The Case The patient presented with wrist pain after a fall on an outstretched hand (FOOSH). View the image taken (Figure 1) and consider what your diagnosis would be.
Read More“Why Are You Calling Me?” The Problem with Patient Transfers in Urgent Care
Lee A. Resnick, MD, FAAFP According to the 2012 Benchmarking Survey from the Urgent Care Association of America, about 4% of urgent care patients are referred to an emergency department (ED) for ongoing care. Some get there by personal vehicle, and others are transferred by emergency services, private ambulance, or other critical-care transportation. Given an average patient volume of 40 patients per day for a single urgent care center, that is 1.5 ED transfers per …
Read MoreClinical Challenge 2: March, 2015
The Case The patient presented with fever and difficulty swallowing. He was visibly anxious, leaning forward on the examination table and spitting into a cup. View the image taken (Figure 1) and consider what your diagnosis would be.
Read More
Fracture of the Penis with Urethral Rupture
Urgent message: Failure to diagnose and, if necessary, repair penile fracture can result in devastating consequences such as stricture, fistula, and long-term voiding difficulty. TAYT ELLISON, MS-3, SHAILENDRA SAXENA, MD, PhD, LAURA KLUG, PharmD, and SANJEEV SHARMA, MD Although penile trauma is not a common presentation in the urgent care setting, it is under-reported because of embarrassment, as are other injuries related to sexual activity. The urgent care clinician should be prepared to evaluate these …
Read MoreEvaluating 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 …
Read MoreClinical Challenge: March, 2015
The Case The patient presented with an upper respiratory infection after vertebroplasty. A chest x-ray was ordered to rule out pneumonia. View the image taken (Figure 1) and consider what your diagnosis would be.
Read More
Urgent Care Evaluation of Fatigue
Ever heard the old (and not so funny) joke about two health-care providers having a conversation at the urgent care center? First provider: “Ever seen a case of _____?” Second provider: “Turns out I have seen plenty of cases . . . just never diagnosed any!” With a nonspecific presenting condition such as fatigue, it is difficult to obtain an adequate medical history and to perform a thorough physical examination unless the differential diagnosis is …
Read MoreAbstracts in Urgent Care: March, 2015
Strict Rest Unnecessary After Concussion Key point: strict rest after a concussion offers no advantage over standard stepwise return to play. Citation: Thomas DG, Apps JN, Hoffmann RG, et al. Benefits of strict rest after acute concussion: a randomized controlled trial. Pediatrics 2015;135:213–223. Concussion treatment has been frequently debated. In this prospective study, patients with concussion were treated with either strict rest for 5 days or standard stepwise return to play. A total of 88 …
Read MoreAbstracts in Urgent Care: February, 2015
Duration of Troponin Testing for ACS Key point: No definitive evidence for the 2-hour troponin rule-out for ACS. Citation: Kelly A–M, Klim S. Prospective external validation of an accelerated (2-h) acute coronary syndrome rule-out process using a contemporary troponin assay. Int J Emerg Med. 2014 Oct 16. doi: 10.1136/emermed-2014-204442. [Epub ahed of print.] As with other serious diseases, ruling out acute coronary syndrome (ACS) is a balance between not missing it and over testing or …
Read More
Serious Pathology Masquerading as Chronic Back Pain
Urgent message: Do not be fooled by the diagnosis made by clinicians before you. Many seemingly benign symptoms can be harbingers of more serious pathology. JESSICA HOFFMANN, MS-4, and JOHN SHUFELDT, MD, JD, MBA, FACEP Chronic back pain is a common presentation in both the urgent care and emergency department (ED) settings. Care-on-demand providers often find themselves deciding how extensive a workup to do for a patient with acute-on-chronic back pain. After a patient has …
Read More