Practice Management
The patient is a 40-year-old male who presents to urgent care with lower-left back pain after an alumni soccer game during his high school reunion weekend. View the images taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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Urgent Message: Inappropriate antibiotic prescribing in the outpatient setting has been a longstanding public health challenge. An educational session implemented in a large Midwestern healthcare system group of urgent care and convenience care clinics resulted in a statistically significant reduction in antibiotic prescribing for acute sinusitis and a statistically significant increase in antibiotic guideline adherence. Dr. Amy K. Rasmussen, DNP, FNP-C ABSTRACT Background: Inappropriate antibiotic prescribing in the outpatient setting is a longstanding problem and …
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Urgent message: Fever in patients presenting to UC is often attributable to viral infections, urinary tract infections, otitis media, cellulitis, or pneumonia. When the source is not apparent after the initial evaluation, however, it is important to expand the differential in order to avoid missing less common, serious diagnoses. Samidha Dutta, DO; Caleb Marsh, OMS-IV, UP-KYCOM; Michael Weinstock, MD CASE PRESENTATION A 74-year-old man with a history of Parkinson’s disease and diabetes presented with 2 …
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Fever: To Treat or Not to Treat? Distinguishing Viral from Bacterial Conjunctivitis Scapular Fractures and Blunt Chest Trauma in Children Sterile vs Nonsterile Gloves for Laceration Repair Bronchiolitis Care: An Update Antibiotic Stewardship and Children Post Paxlovid Rebound Ivan Koay MBChB, FRNZCUC, MD What Are the Consequences of Treating Adult Fever? Take-home point: Fever therapy in adults does not seem to affect the risk of death and serious adverse events. Citation: Holgersson J, Ceric A, …
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Urgent message: Ultrasound can provide essential data in the urgent care evaluation of suspicion of acute appendicitis. Facilitating a rapid diagnosis allows for immediate and appropriate decisions regarding management. Andrew Alaya, MD, MSc INTRODUCTION Appendicitis is thought to be the result of luminal obstruction due to various etiologies (such as lymph node hyperplasia, coprolites, or parasites) which lead to increased mucus production and bacterial overgrowth. This results in wall tension and eventually necrosis and potentially …
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The patient is a 45-year-old male who presents with palpitations for the past 30 minutes. He denies chest pain, dizziness, or syncope. His vital signs are normal aside from tachycardia and he appears to be in no acute distress. View the ECG taken and consider what your diagnosis and next steps might be. Resolution of the case is described on the next page.
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A 43-year-old man presents to urgent care with a rash that he noticed a couple of days ago on his trunk. On exam, there is skin atrophy and multiple smooth papules and hypopigmented oval macules. Upon palpation of the lesions, you find that the examining finger “sinks” into a pit with distinct edges, like the ring of a hernia. The patient is immunocompetent, and his medical history is unremarkable except for lichen planus. He patient …
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The patient is a 16-year-old male who presents to urgent care with pain in the humerus area hours after finishing a baseball game. View the x-ray taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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Michael Weinstock, MD; Gabby Gostigian, MD; and Matthew Delaney, MD Urgent message: Failure to consider subtleties and the context in which a patient presents can lead to insufficient differential diagnoses and missed diagnoses that leave the patient at risk for poor outcomes and the provider at risk for litigation. INTRODUCTION Cellulitis from a wound infection in the urgent care is common, and so is our management: wound care and antibiotics. But consider a scenario in …
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Joshua Russell, MD, MSc, FCUCM, FACEP Recently, a PA I supervise called me about a young woman who came in for hematemesis and melena at home. The provider, let’s call him Tom, told me that the patient had normal vital signs, but he thought she should still go to the ED. I could sense some reluctance in his voice though. It was probably because the patient was just 32 years old and looked well. Understandably, …
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