Practice Management
Urgent message: Whether required due to a crushing blow or close contact with a sharp surface, proper initial care for fingertip and nailbed injuries is essential to good outcomes and can often be administered in the urgent care setting. Scott M. Zimmer, MD Fingertip injuries are one of the most common conditions seen in urgent care and emergency room settings. From door crush to table saw injuries, the proper initial care is vital in the …
Read MoreLee A. Resnick, MD, FAAFP No other specialty requires more expertise in medical decision making than urgent care medicine. We specialize in the evaluation and management of the “undifferentiated patient,” with limited access to diagnostic and consultative resources. Our scope of care is one of the broadest in medicine, requiring breadth of knowledge across disciplines. Our patients are almost entirely new to us, giving us limited clinical and personal insight into their presentations. Finally, constraints …
Read MoreA Short Video About What to Expect in the ED Increases Patient Satisfaction Key point: Showing the video to patients in the ED waiting room increased their satisfaction with the ED experience. Citation: Papa L, Seaberg DC, Rees E, et al. Does a waiting room video about what to expect during an emergency department visit improve patient satisfaction? CJEM. 2008;10:347-354. Assessment of patient satisfaction has become a component of physician and emergency department evaluation. Investigators …
Read MoreThe patient is an 82-year- old man who slipped on the street, experiencing a blow to his right shoulder. He has significant local swelling in the injured shoulder specifically, over the acromioclavicular joint as well as significantly limited range of motion. His distal pulses are normal. View the x-ray taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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It is common knowledge that each patient needs to have a symptomspecific evaluation with each visit, but it is easy to be misled by “frequent fliers” who have presented many times with the same complaint. Take this month’s case, for example: a 37-year-old man with a headache who had four emergency department and two primary care visits before finally receiving the correct diagnosis. Accuracy and vigilance must be the goal of each patient encounter, no …
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Urgent message: Though patients with posterior and bilateral epistaxis should be admitted to the hospital, the vast majority of epistaxis episodes can be treated safely and effectively in the urgent care setting. Nathaniel Arnone, MD, Samuel M. Keim, MD, MS, and Peter Rosen, MD Epistaxis is a common presenting complaint, with 15 per 10,000 people requiring medical attention each year.1 While the presence of blood in the pharynx can cause concern for both patients and …
Read MoreLee A. Resnick, MD, FAAFP I am acutely aware that urgent care medicine is practiced by a variety of specialties. However, family physicians make up the majority of those who practice in urgent care settings, and represent the most likely contingent of practitioners to fill the increasing demand for qualified practitioners in the future. As an organization, UCAOA has made several steps toward improving the competency of family physicians entering the field, from formal training …
Read MoreThe patient is a 7-year-old boy who presents to urgent care at midnight with a four-day history of fever and cough. Two days prior, a throat culture administered elsewhere showed nothing suspicious. The parents brought him to urgent care tonight because of increasing chest pain, which began after the visit to the primary care physician. On exam, you find the child is not in respiratory distress, but has decreased air entry on the left side …
Read MoreVasopressin Not Helpful for Out-of-Hospital Cardiac Arrest Key point: For now, epinephrine remains the only evidence- based drug option in CPR. Citation: Gueugniaud P-Y, David J-S, Chanzy E, et al. Vasopressin and epinephrine vs. epinephrine alone in cardiopulmonary re- suscitation. N Engl J Med. 2008;359:21-30. The ideal drug regimen for use in CPR is a subject of controversy. Epinephrine is the recommended vasopressor agent, but results of some studies suggest that combining epinephrine with vasopressin …
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Urgent message: Sore throat is a complaint commonly encountered in urgent care. Proper evaluation and understanding and use of appropriate antibiotics will foster better patient care and understanding while limiting antibiotic resistance. William Gluckman, DO, MBA, FACEP and Jessica Kay, PharmD Pharyngitis refers to the inflammation or irritation of the pharynx, including the tonsils, and can have many etiologies, including a variety of infections, cancer, allergic reactions, gastroesophageal reflux, or toxic inhalations and ingestions. This …
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