Practice Management
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. …
Read More
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 …
Read More
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 …
Read More
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, …
Read More
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 …
Read More
Urgent message: Life-threatening degrees of rhabdomyolysis can be seen in young, healthy patients with stable presentation and nearly normal examination findings. John Shufeldt, MD, JD, MBA, FACEP and Zana Alattar, MS3 Introduction This case demonstrates the importance of considering and ruling out rhabdomyolysis in patients with myalgia. We describe a case illustrating the management and work-up of myalgia in a young, healthy individual to identify the underlying cause. As with many illnesses, the …
Read More
Urgent message: The ability to differentiate deep vein thrombosis from other diagnoses such as cellulitis is important in choosing the correct treatment option. Jeff Heimiller, MD Case Presentation A 34-year-old male presented with a 1-week of right calf pain that was exacerbated by palpation and walking. He was unable to see his primary care physician that day, so he went to urgent care for evaluation. The patient also reported a sensation of shortness of breath …
Read More
Case A 52-year-old man presented to urgent care with a 2-day history of dizziness. He denies chest pain, syncope, shortness of breath, or diaphoresis. He is not taking any medications, and has no noteworthy personal medical history. Upon exam, you find: General: Alert and oriented X 3, slightly pale Lungs: CTAB Cardiovascular: Irregularly irregular and tachycardic without murmur, rub, or gallop Abdomen: Soft and NT, no pulsatile mass Ext: No peripheral edema, pulses are 2+ …
Read More