Pyuria Poor Predictor of UTI in Nephrolithiasis Key point: Classic symptoms and urine culture are the best indicators of infection in patients with acute nephrolithiasis. Pyuria proved a poor predictor. Citation: Abrahamian FM, Krishnadasan A, Mower WR, Moran GJ, Talan DA. Association of pyuria and clinical characteristics with the presence of urinary tract infection among patients with acute nephrolithiasis. Ann Emerg Med 2013;62(5):526-533. Infection can complicate the diagnosis of acute nephrolithiasis. Patients with both a …
Read MoreClinical Challenge: February, 2014
THE CASE The patient, a 47-year-old woman, twisted her left ankle while playing badminton 24 hours ago and was unable to bear weight on the left foot since then. Examination revealed moderate swelling of the lateral malleolus, no bruise, marked tenderness, slight ankle supination, inversion and adduction. View the image taken (Figure 1) and consider what your diagnosis would be.
Read MorePulse Oximetry, Oral Medication
Q. I am reviewing documentation for a freestanding urgent care center that performs pulse oximetry on every patient they see, regardless of the reason. Is this typical? In some cases, they are billing the case rate code, S9083. Please let me know if this is standard operating procedure. A.Medicare will allow payment for pulse oximetry under two conditions: 1) when it is linked to an appropriate diagnosis code; and 2) if it considered as being …
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Treating the Self-Harming Patient in the Urgent Care
JOHN SHUFELDT, MD, JD, MBA, FACEP He watched her walk through the door at the end of a long, busy day. She was an attractive, well dressed, athletic-looking young lady with a warm smile, the kind of girl he’d want his teenage son to date someday. “Slam dunk,” he thought. “This will be a quick visit and I’ll still get out on time.” The front office team registered her quickly. He suspected that they, too, …
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Sacral Tumor
Urgent message: Each case—and patient presentation—in urgent care must be evaluated on its own merits. Rare diagnoses are possible and “benign” back pain complaints sometimes are not. HEATHER VARLEY, PA-C, and WILLIAM GLUCKMAN, DO, MBA, FACEP Introduction Each day in the urgent care setting, we are presented with a range of various pain complaints, from headaches, to back pain, to extremity pain. These complaints may be the result of injury, overuse, infection, arthropathy, or have …
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Understanding the Freestanding Emergency Department Phenomenon
Urgent message: FSEDs have a role to play in our health care system but it’s not to supplant urgent care centers. ALAN A. AYERS, MBA, MAcc, Experity Introduction Freestanding emergency departments (FSEDs) are walk-in medical facilities—structurally separate and distinct from a hospital—that hold themselves out to provide emergency care to the general public. While they claim many similarities to hospital EDs—capabilities to diagnose and stabilize cardiac arrest, stroke symptoms, breathing problems and trauma—there are also …
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Management of Ocular Complaints in Urgent Care: Part 2
Urgent message: Whether benign or vision-threatening, acute eye conditions seen in the urgent care setting require careful evaluation and triage, based on access to the right tools and knowledge of key clues to diagnosis. SARVOTHAM KINI, MD In Part 1 of this article in January, we discussed urgent care management of foreign bodies in the eye, corneal abrasion, red eye, scleritis, and conjunctivitis. In Part 2, we will review subconjunctival hemorrhage, uveitis, iritis, keratitis, acute …
Read MorePatient Satisfaction Surveys: Seeing Opportunities in Our Failures
Lee A. Resnick, MD, FAAFP It is well known, and exhaustively preached, that a satisfied customer will tell 2-3 people while a dissatisfied one will tell 8-10 (with some estimates as high as 20). Measuring and tracking patient satisfaction has become a focus of most every practice owner, much to the chagrin of their employees, who often view this as a way to publicly embarrass and unfairly harass the staff. And yet, whether we are …
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February 2014
Tricks of the Trade: Ear Suction Kit
Urgent Message: Most urgent care centers don’t carry commercial equipment for ear suction but a kit can be assembled with readily available supplies. Author: Ali Ahmadizadeh, MD, is an attending physician in the Department of Otolaryngology at New York Head and Neck Institute, Lenox Hill Hospital, New York, NY. Otorrhea is one of the most frequent clinical presentations in urgent care. Examination of the ear ideally requires ear suction, but that is not possible in …
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