Practice Management
Urgent message: The ability to differentiate deep vein thrombosis from other diagnoses such as cellulitis is important in choosing the correct treatment option. Jeff Heimiller, MD Case Presentation A 34-year-old male presented with a 1-week of right calf pain that was exacerbated by palpation and walking. He was unable to see his primary care physician that day, so he went to urgent care for evaluation. The patient also reported a sensation of shortness …
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Case A 52-year-old man presented to urgent care with a 2-day history of dizziness. He denies chest pain, syncope, shortness of breath, or diaphoresis. He is not taking any medications, and has no noteworthy personal medical history. Upon exam, you find: General: Alert and oriented X 3, slightly pale Lungs: CTAB Cardiovascular: Irregularly irregular and tachycardic without murmur, rub, or gallop Abdomen: Soft and NT, no pulsatile mass Ext: No peripheral edema, pulses are 2+ …
Read MoreCDC Attributes 200+ Cases of Coagulopathy to Synthetic Cannaboids Key point: “Marijuana alternatives” are widely available—and being blamed for multiple deaths. Citation: Moritz E, Austin C, Wahl M, et al. Notes from the field: outbreak of severe illness linked to the vitamin K antagonist brodifacoum and use of synthetic cannabinoids—Illinois, March–April 2018. MMWR Morb Mortal Wkly Rep. 2018;67:607–608. The Centers for Disease Control and Prevention revealed that they have received more than 200 reported …
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Case The patient is a 3-year-old female who is brought to your urgent care center by her parents, who report that she has been limping and crying intermittently seemingly without reason for the past several hours. Her father says she cries acutely when picked up, but that she calms down quickly with comforting. View the images taken (Figure 1 and Figure 2) and consider what the diagnosis and next steps would be. Resolution of the …
Read MoreEliminating disruption, distraction, and dissatisfaction is paramount to delivering efficient and high-quality care these days. More than ever, urgent cares are competing to differentiate themselves by moving patients through the encounter faster and with a more reliably exceptional experience. We’ve adopted slick technologies and reconfigured work flows to improve care delivery. So, why do our teams still struggle with consistency? Why do we still see high levels of burnout and turnover—and what can we …
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Case A 3-year-old girl was brought to urgent care with small widespread vesicles, including on her palms and soles. She had begun to develop painful oral vesicles, as well, and was refusing to eat. The rash began a few days after flu-like symptoms of fever, sore throat, cough, and headache. View the photo and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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Urgent message: Typical drooling is no cause for alarm in infants and toddlers. However, excessive drooling accompanied by fever or other various red flags could be signs of more serious concerns such as retropharyngeal abscess, Ludwig angina, or upper airway obstruction. Recognition should trigger a thorough evaluation by the urgent care provider. Katherine P. Dureau, MD CASE A 24-month-old previously full-term and vaccinated male presents to an urgent care center with 24 hours …
Read MoreSome Oral Antibiotics Up Risk for Kidney Stones Key point: Oral antibiotics are associated with an increased risk for nephrolithiasis in adults and children, with the risk highest in those exposed at a younger age. Citation: Tasian GE, et al. Oral antibiotic exposure and kidney stone disease. J Am Soc Nephrol. 2018; May 10. [Epub ahead of print] The prevalence of kidney stones has increased 70% during the last 30 years, with the most …
Read MoreFactors Influencing Provider Efficiency—or Inefficiency—in the ED Key point: Emergency department study on provider efficiency has relevance to urgent care. Citation: Bobb MR, Ahmed A, Van Heukelom P, et al. Which practices make for efficient emergency department providers? Acad Emerg Med. December 18, 2017. [Epub ahead of print] This mixed-methods study published in Academic Emergency Medicine identified five practices/behaviors that increased provider efficiency in the emergency room and two practices that did not. What makes …
Read MoreACP Eases Up on A1c Ceiling for Patients with Type 2 Diabetes Key point: The American College of Physicians suggests slightly higher hemoglobin A1c target levels for patients with type 2 diabetes. Citation: Qaseem A, Wilt TJ, Kansagara D, et al. Hemoglobin A1C targets for glycemic control with pharmacologic therapy for nonpregnant adults with type 2 diabetes mellitus: a guidance statement update from the American College of Physicians. Ann Intern Med. March 6, 2018. [Epub ahead …
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