The patient is a 73-year-old woman who presents with a foreign body (a piece of wood, specifically) sticking out of a scratch on her hand. She reports that she fell in her yard. In addition, you discover that she has local pain and swelling of the left wrist. 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.
Read MoreClinical Challenge: July 2008
The patient is a 2-year-old girl who experienced a blow to the left foot when she jumped from an unspecified height while playing. The parents were unaware at the time the injury occurred, but toward evening the girl refused to apply weight to her left foot. On exam, the foot is mildly swollen and tender. Otherwise, there are no remarkable findings. View the x-ray taken (Figure 1) and consider what your diagnosis and next steps …
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The Case of a 24-Year-Old Man with Abdominal Pain
Our goal with the Bouncebacks series is to maximize patient safety and minimize the urgent care provider’s medico-legal exposure. As Greg Henry wrote in the forward of our Bouncebacks! book, “The smart doctor is not the one who learns from his own mistakes. The smart doctor is the one who learns from the mistakes of others.” Our case this month involves a young man with vomiting and diarrhea and abdominal pain. This typical urgent care …
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Acute Ankle Injuries in the Urgent Care Setting
Urgent message: Working knowledge of anatomy and familiarity with radiograph reading, injury classification, treatment options, and criteria for referral support positive long-term outcomes in patients with acute ankle injuries. Janet D. Little, MD and William E. Saar, DO Acute ankle injury is one of the most common musculoskeletal injuries in the athlete and sedentary person alike. The yearly incidence of ankle injuries varies between resources, but ranges from 1 million to 5 million per year …
Read MoreFighting the Urge to Judge
Lee A. Resnick, MD, FAAFP In a previous column, entitled “Rekindling the Doctor-Patient Relationship”, I focused on methods for developing trust with your patients. The intention of building trust is to enhance patient relationships and ensure positive patient encounters. Judgments can be a significant obstacle to that process, however. In fact, judgments are the surest way to undermine trust, and can potentially lead to delay of appropriate care or to misdiagnosis. Judgments are second only …
Read MoreAbstracts in Urgent Care: July/August, 2008
It’s not Easy for ED Patients to Get Follow-Up Care Key point: Only 23% of attempts to schedule an outpatient follow-up appointment were successful in this study of callers posing as ED patients without primary care physicians. Citation: Vieth TL, Rhodes KV. Nonprice barriers to ambulatory care after an emergency department visit. Ann Emerg Med. 2008;51(5):607-613. Almost half of emergency department patients are dis- charged with instructions to follow up with an outpatient clinic or …
Read MoreAbstracts In Urgent Care: June, 2008
Prevalence of UTI in Children Key point: Prevalence is highest in infants younger than 3 months, girls with fever, and uncircumcised boys. Citation: Shaikh N, Morone NE, Bost JE, et al. Prevalence of uri- nary tract infection in childhood: A meta-analysis. Pediatr Infect Dis J. 2008; 27:302-308. During the past decade, many studies have assessed the preva- lence of urinary tract infection (UTI) in children with fever. In- vestigators conducted a meta-analysis of data from …
Read MoreClinical Challenge: June, 2008
The patient is an 80-year-old man who presents to urgent care with low back pain of two weeks duration. He is hemodynamically stable and has a normal neurological exam. His personal medical history reveals hypertension, for which he is being treated. Blood pressure is 140/80, pulse 63. 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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Diabetic Emergencies in the Urgent Care Setting
Urgent message: Patients with glucose levels either too high or too low often require immediate, potentially life-saving interventions in the urgent care setting. These patients are often found to be diabetic. Allan F. Moore, MD, Nicolas Abourizk, MD, Jeffrey Collins, MD, MA Diabetes is a common chronic disease affecting approximately 7% of the United States population. Of these individuals, 17.5 million carry a diagnosis of diabetes and over 6 million are undiagnosed. An estimated 54 …
Read MoreVisioning for the Future of Urgent Care
Lee A. Resnick, MD, FAAFP The Urgent Care Association’s spring convention in New Orleans, April 28–May 2 culminated an incredible year for our association. The convention was attended by 660 urgent care practitioners and administrators, and represented an incredible show of strength for our industry, the discipline of urgent care medicine, and UCA. As witnessed by those of you who have attended many of our recent conventions, UCA has achieved remarkable growth in only four …
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