Practice Management
Case The patient is a 62-year-old woman who presents to your urgent care center with a feeling of palpitations, which began the previous evening. She has no chest pain or shortness of breath, but does feel “clammy.” She takes no medications. Her history includes MI and CABG 5 years ago. Upon exam, you find: General: Alert and oriented X 3, skin color good but clammy Lungs: CTAB Cardiovascular: Tachycardic and regular without murmur, …
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Urgent message: Early diagnosis and management of multiple sclerosis are crucial for long-term prognosis. Urgent care providers must be vigilant with proper history taking and thorough physical examination when looking for signs and symptoms of early MS. Waqas Memon, MD, Zonaira Shabbir, OMS IV, and Muhammad Akhtar, MD, FACP Introduction In the early course of multiple sclerosis (MS), the initial symptoms are nonspecific and intermittent, which makes the diagnosis challenging.1 Focusing on common symptoms and …
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Case A 72-year-old man brought his wife into the urgent care center because she woke up with a raw throat and fever. However, he also asks to see a clinician to ask about multiple black skin lesions on his cheeks and eyelids. Once in the exam room, he notes that he spent more than 40 years in the landscaping business, getting considerable sun exposure. He knows that put him at risk for skin cancer. In …
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Urgent message: Children presenting to the urgent care center are often in a state of distress and agitation—to the extent that they may be difficult to treat when it comes to certain procedures. The parental papoose technique may help soothe the patient—and the parent—making effective treatment more accessible. Oscar D. Almeida, Jr., MD, FACOG, FACS It is common for a young child to enter our urgent care center calmly—while being held by a parent, only …
Read MoreAntimicrobial stewardship is defined as a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms. Stewardship initiatives in the hospital are paving the way for the rest of healthcare through education campaigns, monitoring, and restrictions. Outpatient practice is beginning to catch up as the stories of resistance grow and the lines between nosocomial and community-acquired infections blur. …
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Urgent message: Previously undiagnosed hypertension is common among ambulatory patients, and urgent care providers are often the first to recognize and diagnose this condition. Initiating treatment, testing, and providing patient education and follow-up are well within the scope of urgent care practice and help ensure positive outcomes. Being attentive to the presentation and care of hypertensive emergencies is also paramount. Taylor Fischer MMS, PA-C and Rebecca L. McClough, MPAS PA-C Hypertension (HTN) affects …
Read MoreWHO Announces ICD-11, Coming Next Year Key point: New set will reflect current terminologies and classifications, integrate more smoothly with new technologies. Citation: World Health Organization. WHO Releases New International Classification of Diseases (ICD 11). June 18, 2018. Available at: http://www.who.int/news-room/detail/18-06-2018-who-releases-new-international-classification-of-diseases-(icd-11). Accessed August 14, 2018. ICD-10 was released in 2015, but according to the World Health Organization (WHO) we can already expect the next revision, ICD-11, sometime early in the next decade. ICD-11 is supposed …
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Case The patient is a 27-year-old male who presents to urgent care with foot pain, for which he says there is no explanation. With probing, he reveals that he is a “fanatic” about running, and that the pain has persisted for close to 7 months. View the images taken and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page. Differential Diagnosis Capsulitis Freiberg …
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Case The patient is a 61-year-old man who presents to the urgent care center with lightheaded dizziness, which he says started several hours prior to arrival. He denies chest pain, syncope, and shortness of breath but says he feels “clammy.” He is not taking any medications on a regular basis has no history of myocardial infarction, but he had a stent placed 8 years ago. Upon exam, you find: General: Alert and oriented X 3, …
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Case The patient is a 28-year-old man who presents to urgent care with a fever and complaints of tiredness, myalgia, and sore throat. You note that he has pink, scaly papules on his palms and soles. He also has patchy alopecia developing on his scalp, which he says is a very recent development. View the photo and consider what your diagnosis and next steps would be. Resolution of the case is described on the next …
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