Clinical

  Case An 18-year-old woman was swimming in the Atlantic Ocean off the coast of Florida when suddenly she experienced a sharp, stinging pain on her arm. That evolved into a severe ache shortly, accompanied by a painful red lesion. She vomited on her way to your urgent care center, and still feels nauseous. She is also complaining of muscle cramps. View the photo and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.Read More

“Grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.” I’m not usually one to quote religious text, but this excerpt from the Serenity Prayer resonates. Perhaps the most pointed and overwhelming challenge facing physicians today is the loss of control over our profession. The last three decades have seen dramatic erosion of the status, ownership, and independence of physicians. The root cause is multifactorial to be sure, with influence from powerful special interests across multipleRead More

  Case A 38-year-old female patient presents with acute shoulder pain following a fall on an outstretched arm during a spring skiing vacation. There is a normal appearance to the shoulder, but significant pain even with minimal attempts at range of motion. The clavicle and elbow are nontender. Neurovascular status is intact. View the image taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.Read More

Urgent message: Septic arthritis can lead to significant morbidity if not treated in a timely manner. Bacteria within the synovial space can lead to rapid joint destruction and irreversible loss of function. When patients present to the urgent care center with a red, hot, swollen, painful joint, every attempt must be made to rule out this disease entity to prevent significant morbidity and mortality. Introduction Patients frequently present to urgent care with a red, swollen, and painful joint in the absence of trauma. Causes of acute monoarticular arthritis can rangeRead More

Urgent message: The simplest explanation for a mundane symptom may not always reflect the correct diagnosis. Urgent care providers should consider all the possibilities in order to reach the correct conclusion as early as possible, or risk missing a more serious underlying diagnosis. Introduction Sometimes a simple complaint results in a common diagnosis, but other times a rare diagnosis will be discovered. The following case illustrates the importance of considering a wide differential and obtaining appropriate follow-up. Further morbidity was prevented by the vigilance and care of the urgent careRead More

Case The patient is a 62-year-old woman who presents to the urgent care center after 1 hour of intermittent dizziness and feeling of palpitations. She has no chest pain, fever, vomiting, or diarrhea. Further history reveals that she has a history of anxiety, which is manifested by intermittent feeling of heart “palpitations.” Her primary care doctor is treating her with a selective serotonin reuptake inhibitor (SSRI) for anxiety. Upon exam, you find: General: Alert and oriented; mildly tachypneic Lungs: CTAB Cardiovascular: Regular and tachycardic without murmur, rub, or gallop Abdomen:Read More

Tracking Antibiotic Prescriptions for Nonbacterial Acute URI Key point: Patients were more likely to receive prescriptions from mid- or late-career physicians and from those with higher daily patient volumes. Citation: Silverman M, et al. Antibiotic prescribing for nonbacterial acute respiratory infections in elderly persons. Ann Intern Med. [Epub ahead of print May 9, 2017] This retrospective analysis of linked administrative health care data was drawn from 8,990 primary care physicians and 185,014 patients who presented with a nonbacterial acute upper respiratory infection (AURI). The study was designed to determine theRead More

Case This 42-year-old woman presents to your urgent care center with a 2-hour history intermittent dizziness and vomiting. She denies diarrhea or exposure to ill persons. Further history reveals that she has recently had some epigastric discomfort. In the exam room, she is alert and oriented. She seems comfortable, in fact. In addition, you find: Lungs: Minimal bilateral symmetric wheezing Cardiovascular: Regular rate and rhythm without murmur, rub, or gallop Abdomen: Soft and nontender without rigidity, rebound, or guarding. No epigastric discomfort with palpation Extremities: No pain or swelling ofRead More