Practice Management
The patients is an 88-year-old woman with 3 weeks of dizziness but no complaints of chest pain/discomfort, shortness of breath, focal neurological signs, or diaphoresis. An ECG is performed by staff prior to clinician evaluation. Upon exam, you find: General: Alert and oriented X 3, ambulatory Lungs: Clear to auscultation Cardiovascular: RRR without m/r/g Abdomen: Soft and NT without r/r/g Extremities: Normal Review the ECG and consider what your diagnosis and next steps would be. …
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The patient is a 59-year-old man who presents with pain in his elbow. He says he was experimenting with his son’s hoverboard, hanging on to a pole to steady himself. He lost his balance and fell, with his right arm taking the brunt of the impact. His range of motion is limited by both pain and swelling. View the images taken and consider what the diagnosis and next steps would be. Resolution of the case …
Read MorePractice of Urgent Care: Rude Patients May Do More than Ruin Your Mood Key point: Individual and team performance of clinicians suffer in both quality of diagnostic approach and procedural skills when dealing with rude patients. Citation: Riskin A, Erez A, Foulk TA, et al. The impact of rudeness on medical performance: a randomized trial. Pediatrics.2015;136(3):487-495. Patients in urgent care commonly have unrealistic demands and expectations. When they make disparaging remarks, it’s easy to feel …
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Urgent message: Cerebral venous sinus thrombosis (CVST) occurs when a blood clot forms in the venous sinuses within the brain, preventing drainage of blood. It can cause blood cells to break down and leak into the brain tissues, forming a hemorrhage. This can result in stroke. CVST affects about 5 people in 1 million per year. Aasia Ferdous, DO and Jordan Miller, DO CASE PRESENTATION A 30-year-old female presented to urgent clinic with a headache …
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The patients is a 47-year-old woman undergoing chemotherapy for breast cancer with 1 day of  several red, flaccid bullae on her leg as well as fever, cough, and shortness of breath. View the image 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: Toddler’s fractures are a common cause of limp and failure to bear weight in children under 4 years of age. Recent research shows wide variation in management of these stable fractures, favoring a less conservative approach. Amy E. Pattishall, MD The case: A 14-month-old male is brought to your urgent care by his parents immediately after an injury to his right leg at the park. The boy was riding down the slide on …
Read MoreTelemedicine remains a hot topic of debate in urgent care circles. In fact, it seems like every urgent care conference I attend lately has a telemedicine track or expert panel. JUCM recently featured a point-counterpoint discussion between two industry leaders, Stanford Coleman, MD, MBA, FAAP and William Gluckman, DO, MBA, FACEP—whose opinions on the topic are as well-reasoned as they are divergent. So, let me add my two cents. The discussions and analyses I’ve been …
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Case The patient is an 80-year-old man with history of hypertension and high cholesterol who presents with rhinorrhea and cough. On further history, he admits to 2 months of intermittent dizziness, not worsening. He denies any chest pain/discomfort, SOB, or sweating. No neuro symptoms. On exam, you find:  General: A&O, NAD Lungs: Clear bilaterally Cardiovascular: Regular rhythm, without m,r,g Abdomen: Soft and nontender Ext: No edema or asymmetry, pulses are 2+ and equal in all …
Read MoreRush for Outpatient Stress Test Recommendation (Finally) Examined Key point: Rapid outpatient stress testing (ie, within 72 hours), which has long been recommended by the American Heart Association, did not decrease the short-term risk of major adverse cardiac events (MACE). Citation: Natsui S, Sun BC, Shen E, et al. Evaluation of outpatient cardiac stress testing after emergency department encounters for suspected acute coronary syndrome. Ann Emerg Med. April 5, 2019. [Epub ahead of print] The …
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Case The patients is a 48-year-old woman who presents with a single lesion on her cheek/face. As a healthcare worker herself, she says she is concerned that the excoriation might get infected. She denies knowing anything about the possible cause, but insists on receiving treatment. Notably, she is a frequent visitor to your urgent care center in spite of the fact that she is in excellent physical health. However, she has been diagnosed with borderline …
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