Urgent message: Sound finances and proven business management skills may be the most valuable assets for the urgent care operator looking to capitalize on past successes by expanding. by Michael Gotlieb Introduction Urgent care owners, like many other entrepreneurial businesspeople, have great opportunities in front of them, yet need assistance at times. Sometimes, that “assistance” is purely financial. Most often in inflection point cases like expansion; however, it is a combination of financial and business acumen …
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37-year-old diabetic female feeling weak after switching diuretics
The patient is a 37-year-old female who presented with a history of longstanding hypertension and diabetes mellitus. She had recently started on a new diuretic, and felt very weak and lightheaded. Her blood pressure was 88/56 mmHg with a pulse of 44 beats per minute. After reviewing the ECG, consider the following questions: 1. Based on this ECG, what type of diuretic is she likely to be taking? 2. How should she be managed?
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September 2010
Abstracts in Urgent Care: September, 2010
Non-intravenous Midazolam Effectively Terminates Pediatric Seizures Key point: A meta-analysis revelas that non-IV midazolam is as effective as or superior to IV or rectal diazepam for stopping seizures in children and young adults. Citation: McMullan J, Comilla S, Panciolo A, et al. Midazolam versus diazepam for the treatment of status epilepticus in children and young adults: A meta-analysis. Acad Emerg Med. 2010; 17(6): 575-582. Although intravenous (IV) lorazepam is considered first-line therapy for status epilepticus, …
Read MoreDeveloping Data: September, 2010
In each issue on this page, we report on research from or relevant to the emerging urgent care marketplace. This month, we present data that shed light on reasons parents may be taking their children to the emergency room instead of to their pediatricians, even for non-urgent care. Researchers at Columbia University Medical Center in New York City report that between 1997 and 2006, there’s been a shift in those reasons; where perceived need for …
Read MoreUnderstanding the True Value of the Occupational Health Product
Your clinic needs to sell occupational health services based on their perceived value to the buyer. Hence, you must learn to assess each buyer’s perception of what constitutes value to them before discussing your services. Traditionally, such an assessment is done through the use of astute questioning (e.g., “What is most important to you in selecting an external provider of occupational health services?”). Once you have an understanding of what motivates the prospective buyer, only …
Read MoreCleared for Takeoff
JOHN SHUFELDT, MD, JD, MBA, FACEP I like checklists. I use them while treating patients, flying, cooking, and training. Despite the fact that I have a few thousand hours behind the controls of a variety of aircraft, I still use them every time I fly. Why then, if I believe I am a fairly competent pilot, do I need to rely on something as pedestrian as a checklist for things that I have done countless …
Read MoreCoding for Rectal Strep and Injury Exposure Visits, Billing for Slit Lamp Exams, and a Follow-up on Splinting
DAVID STERN, MD (Practice Velocity) Q. What is the correct ICD-9 code for rectal strep? Question submitted by Cindy Reisbeck, Littleton, CO A. There are several possible codes. The specific ICD-9 code would depend on a more specific diagnosis. For streptococcal infections in the rectal or perirectal area, there are several possible correct codes, as streptococcal species can cause multiple different types of localized conditions. For cellulitis, the correct code would be 566; for erysipelas, …
Read MoreClinical Challenge: September, 2010
In each issue, JUCM will challenge your diagnostic acumen with a glimpse of x-rays, electrocardiograms, and photographs of dermatologic conditions that real urgent care patients have presented with. If you would like to submit a case for consideration, please e-mail the relevant materials and presenting information to [email protected]. The patient is a 62-year-old who presents with a primary complaint of right shoulder pain that developed over time. The patient denies any trauma. The patient is …
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Promethazine-induced Tissue Necrosis: A Case Presentation
Urgent message: Due to versatility, the urgent care clinician will find promethazine an appropriate choice in many situations. Awareness of potentially serious side effects maximizes the chance of good outcomes while minimizing risk. Shailendra Saxena, MD, PhD, Naureen Rafiq, MD, Liji George, MD, Cara Olsen, PharmD, and Mikayla Spangler, PharmD Introduction Promethazine (Phenergan) is a drug commonly prescribed in emergency departments and urgent care clinics for treatment of a variety of conditions (Table 1). Because …
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