This feature will challenge your diagnostic acumen with a glimpse of x-rays, electrocardiograms, and photographs of 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]. Case A 12-year-old presents with severe ankle pain and swelling after twisting an ankle while jumping off a tree limb. View the image taken (Figure 1) and consider what …
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Blurred Vision and Painful Red Eye in a 40-Year-Old Patient
A 40-year-old man presents to an urgent care center with an acutely painful red eye in which he has blurred vision. He notices a bit of a headache and that there are some halos around lights, but he says that he has not experienced nausea or vomiting. When reviewing his medical history with you, he notes that he recently started taking a new antidepressant. View the image taken (Figure 1) and consider what your diagnosis …
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Flashes of Light, Floaters, and Blurred Vision
A 70-year-old man presents with blurred vision and a nasal-field defect in one of his eyes. He reports that before arriving in the emergency department, he saw flashes of light and floaters, accompanied by a shower of black dots blocking his vision. Figure 1 shows what the physician sees when examining the patient’s eye with indirect ophthalmoscopy and scleral depression. Consider what your diagnosis would be.
Read MoreClinical Challenge: September, 2015
Case A patient presents after a fall during a soccer game, reporting severe pain in one thumb and difficulty grasping anything between the thumb and forefinger. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is described on the next page.
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Delayed Prescribing of Antibiotics for Respiratory Tract Infections
Urgent message: Respiratory tract infections are a common complaint in the urgent care setting. Many patients present with the expectation of receiving antibiotics because they have usually done so. The rise of anti biotic-resistant infections requires that we take a close look at our prescribing habits and the need to reeducate patients on the harm of overusing antibiotics. Delayed prescribing offers a way to both satisfy patients and reduce the use of antibiotics in respiratory …
Read MoreAbstracts in Urgent Care: September, 2015
SEAN M. McNEELEY, MD Adverse Events Unlikely in Patients with Negative Findings on Cardiac Evaluation Key point: Adverse events in patients admitted with negative findings on cardiac evaluation are very infrequent. Citation: Weinstock MB, Weingart S, Orth F, et al. Risk for clinically relevant adverse cardiac events in patients with chest pain at hospital admission. JAMA Intern Med 2015;175:1207–1212. In this 5-year retrospective study of patients seen in an emergency department for symptoms potentially representing …
Read MoreClinical Challenge: September, 2015
A 41-year-old man presents with left-flank pain. His past medical history is unremarkable. An incidental finding is evident on images of the kidney, ureter, and bladder. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is described on the next page.
Read MoreEHR Interoperability: A Bridge to Nowhere
Lee A. Resnick, MD, FAAFP In the beginning, interoperability and health information exchange (HIE) were key selling points for physicians considering adoption of and investment in electronic health records (EHRs), but today most are left feeling misled, stranded on a bridge that leads nowhere. The Healthcare Information and Management Systems Society (HIMMS) defines EHR interoperability as “the ability of different information technology systems and software applications to communicate, exchange data, and use the information that …
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Soft-Tissue Infection Due to Vibrio parahaemolyticus and Aeromonas hydrophila
Urgent message: Failure to recognize and treat the early development of skin and soft-tissue infection from a stingray envenomation may result in significant tissue necrosis and systemic inflammatory response syndrome. WILLIAM A. WOOLERY, DO, PhD, MS, MBA, FACOFP Stingray injuries to humans are very common but rarely fatal. Approximately 2000 cases are reported annually in the United States.1–3 At my rural hospital on the west coast of Florida, we see an average of 45 such …
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Urgent Care Management of Animal Bites and Stings
Urgent message: Because bite and stings can be sustained in a variety of settings from many different animals and can transmit a wide variety of infectious agents, urgent care providers should have specific knowledge about treating wounds from mammals, nonmammals, and marine animals. ALEXANDER NATHANSON, MD Practitioners at urgent care centers often see patients who have sustained animal bites or stings. In addition to causing structural damage to tissues, bites and stings expose patients to …
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