Practice Management
John J. Koehler MD, ABPM(OM) I trained in Emergency Medicine in the 1980s and learned to use a slit lamp as an intern; it’s a skill that continues to serve me to this day. We had “opti-spuds” to remove foreign bodies and “opti-burrs” to debride rust rings. This was considered a core skill in my training. This is why, when I started Physicians Immediate Care in 1987, I bought a slit lamp as well as …
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Urgent message: While management of infection is often guideline-dependent, studies have revealed disparities in the treatment and management of several infections among clinical sites in the United States. Current literature suggests social determinants of health and other factors may also influence treatment and management of disease states. Derrick Murcia, BS; Ryan Loh, PhD; Omar Samara, BS; Anthony Monzon, MBA; Sterling Lee, BA; Alex Nguyen, BS; and Lindsey E. Fish, MD Citation: Murcia D, Loh R, …
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A 70-year-old male presents to urgent care with confusion. On exam, the patient is tachypneic and is, indeed, confused but is able to follow commands. View the initial ECG taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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A 41-year-old woman with a history of systemic lupus erythematosus presents for evaluation of painful areas that had developed on her upper, outer arms and lateral thighs over the past month. She reports that while the affected areas were initially smooth, some had begun to ulcerate. View the photo taken and consider what your diagnosis and next steps would be.
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The patient is a 35-year-old male with a soft tissue mass in the mid index finger of his right hand. He reports that he noticed it only recently, and denies any other symptoms. View the x-ray taken and consider what your diagnosis and next steps would be.
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The scourge of the COVID-19 pandemic has affected urgent care practices deeply, beyond what you already know firsthand. In addition to fluctuations in patient visits, efforts to keep staff safe, and reorganizing locations to meet whatever need was greatest at a given moment, the “typical” urgent care staffing model evolved at an accelerated pace between 2019 and today. The proportion of centers in which physician assistants and nurse practitioners treat patients with only remote …
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Urgent message: Psoas (or iliopsoas) abscess, although rare, is a cause of back pain associated with high morbidity and mortality. Proper diagnosis requires the physician to recognize signs in the history and physical examination that are suggestive of a potentially serious spinal condition prompting further workup. Fabrizia Faustinella, MD, PhD and L. Alexandre Frigini, MD Citation: Faustinella F, Frigini LA. A common compliant with an unlikely diagnosis: psoas abscess in the urgent care center. J …
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Urgent message: Often, patients that could safely be treated for lacerations in the urgent care center are referred to the emergency room due to the quest for expediency, or even providers being out of practice with treating such wounds on site during the COVID-19 pandemic. However, doing so contributes to the degradation of acuity in urgent care while delaying care and raising costs. Anesthesia for wound repair can be achieved in many ways, typically with …
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Urgent message: Utilization of validated scoring systems and clinical decision-making tools can enable the urgent care provider to manage many patients presenting with symptoms of deep-vein thrombosis in the urgent care center, reducing the need for costly referral to the emergency room. Daniel Eisner, DMSc, PA-C ABSTRACT Management of venous thromboembolism accounts for $10 billion in medical spending annually, with much of the cost attributable to emergency room visits. Conversely, managing VTE patients in the …
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Ivan Koay MBChB, MRCS, FRNZCUC, MD Kinesiology Taping for Shoulder and Chest Wall Injuries Take-home point: Kinesiologytaping (KT) combined with standard care appears to be more effective for acute pain reduction in patients with uncomplicated traumatic injury of the shoulder or chest wall. Citation: Bakker M, Bon V, Hubrechts B, et al. Kinesiotaping for acute pain due to uncomplicated traumatic injury of the shoulder or chest wall. Am J Emerg Med. 2022;58:197-202. Relevance: KT offers …
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