Journal of Urgent Care Medicine

Management of Palpitations in Urgent Care

Urgent message: Patients with palpitations often present to urgent care clinics. Making the correct diagnosis requires knowledge of underlying pathophysiology and thorough differential diagnosis. EBRAHIM BARKOUDAH, MD, and JEFFREY P. COLLINS, MD Case Record A 75-year-old woman with no prior history of cardiac disease complained of “palpitations” but neither lightheadedness nor syncope. She denied excess caffeine intake or use of illicit drugs and had no other significant past medical history on triage. The patient’s initial …

It Depends on What the Meaning of the Word ‘Is’ Is

Lee A. Resnick, MD, FAAFP Much has been written of late about use of emergency services by patients covered by Medicaid. For some time, consensus has been that Medicaid patients overuse emergency services for non-emergencies. The emergency department (ED), it was thought, served as the de facto primary care physician for this because of problems with access and lack of pricing pressures to deter use. Until recently, supportive data were lacking and the notion of …

Abstracts in Urgent Care: July/August, 2012

Doctor Panels Recommend Fewer Tests for Patients Key point: The American Board of Internal Medicine, in partnership with nine medical specialty groups, is urging physicians to perform 45 common tests and procedures less frequently. Citation: http://www.nytimes.com/2012/04/04/health/doctor-panels-urge-fewer-routine-tests.html?_r=1 An article in the New York Times notes that unnecessary treatment accounts for an estimated one third of medical spending in the United States. The initiative, called Choosing Wisely, is aimed at both physicians and patients. Among the tests …

Clinical Challenge: July/August, 2012

The patient, a 23-year-old male, presented with knee pain and trauma. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is described of the next page.

High-Risk Conditions Presenting as Back Pain (Part 4)

Urgent message: Back pain with incontinence and focal neurological changes are red flags for serious conditions. ERICA MARSHBURN, BS, BA, and JOHN SHUFELDT, MD, JD, MBA, FACEP Low back pain is a common presentation in the urgent care setting and it is important for providers to be aware of signs and symptoms that could indicate a more serious condition than nonspecific muscular pain. Be sure to make a thorough evaluation of your patients and pay …

Management of Acute Hyperglycemia in Urgent Care (Part 1)

Urgent message: Acute hyperglycemia is a common and potentially challenging problem in urgent care that deserves to be managed appropriately based on the best available evidence and suitable consideration of the associated complexities. ANTHONY J. PICK, MD, CDE, DAVID L. PICK, MD, FAAFP, and LOWELL R. SCHMELTZ, MD Hyperglycemia is common in acute care settings such as emergency rooms (ERs) or urgent care centers. Stress-induced hyperglycemia can result from an acute process, such as infection, …

What a pain!

Pain management in urgent care is a minefield of monstrous proportions. The controlled substance prescribing landscape is body trapped indeed, and the well-meaning, unsuspecting physician stands right in the middle. The regulatory, criminal and litigious nature of this highly charged issue is not to be trifled with. Like it or not, physicians are essentially the licensees of some of the most dangerous and destructive weapons of modern medicine, and we have a clinical, legal and …

Clinical Challenge 2: June, 2012

The patient, a 42-eyar-old female, presented with a complaint of red bumps on her lower extremities that were warm and painful to touch. She reported that the lesions appeared 2 days ago, and she was running a fever and feeling tired and generally ill (headache, joint stiffness, and body aches). The patient denied taking any medication except for ibuprofen for symptom relief. On exam, multiple poorly defined erythematous nodules and plaques were observed in a …

Lymphadenopathy in urgent care: evaluation and management

Urgent message: Lymphadenopathy is a common presenting issue in urgent care. Most cases are benign, but be on the alert for “red flags” that could signal malignancy. MARIA V. GIBSON, MD, PHD, and DANIEL A. CHERRY, MD Consider how you would manage the following patient presenting with lymphadenopathy. A 39-year-old male truck driver presented to the urgent care clinic with a 2- to 3-week history of “swollen glands” in both sides of his groin. They …

M.O.C.: What a Mess!

“Marauding Our Cash,” Mockery of Certification, “Malady of Commonsense.” I’ve had a lot of fun coming up with new definitions for the wildly unpopular Maintenance of Certification, or M.O.C. Back in 2003, the American Board of Medical Specialties (ABMS) and their member boards, decided unilaterally that 8 years of education, 3 to 7 years of residency training, MCATs, USMLE Parts I, II and III, specialty board certification exams, annual continuing medical education (CME) requirements, “specialty …

Login to JUCM