Case A 19-year-old man presents to urgent care with a 5-day history of a dry cough. He says he has “felt warm” but didn’t think to check his temperature. He also complains that he has been weak, with a decreased appetite. He notes that his girlfriend had an upper respiratory infection a couple of weeks ago, but other than that he’s had no exposure to anyone who’s been sick. He has not traveled anywhere recently, …
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Initially Missed Diagnosis of Quadriceps Partial Tendon Tear
Urgent message: Quadriceps tendon tears are misdiagnosed frequently, leaving patients at excessive risk for long-term disability. Early identification and immediate referral for further care—often, surgery—is necessary for optimal outcomes. Low-riding patella (patella baja) commonly seen in complete tendon tears. (Photo courtesy of Wikimedia Commons.) Introduction Musculoskeletal injuries are among of the most common problems seen in the urgent care setting. Quadriceps tendon tears are uncommon injuries, with an incidence of approximately 1.4/100,000 per year. Consequently, …
Read MoreAbstracts in Urgent Care – January 2017
How Much Time with the Physician is “Enough” Time? Key point: Length of time with a provider may not be related to patient experience. Citation: Elmore N, Burt J, Abel G, et al. Investigating the relationship between consultation length and patient experience: a cross-sectional study in primary care. Br J Gen Pract. 2016;66(653):e896-e903. This study documented the length of stay for 529 patients who were seen by a primary care physician. Patients were then asked to fill out a survey about …
Read MoreHow to Avoid Burnout? The Answer Is in the Exam Room
Much has been written of late regarding physician burnout. And why not? The rates of burnout are astronomical and the consequences are scary. Consider these statistics: Medscape Physician Lifestyle Report 2015 notes that almost half of physicians report experiencing burnout. The Physicians Foundation’s 2014 Survey of America’s Physicians reveals that physicians are far more likely to burn out than professionals in any other line of work, and that only 40% of physicians over 46 years …
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Fever, Conjunctival Injection, and a Facial Papule
Case A mother brings her 10-year-old son to an urgent care center with a fever, conjunctival injection, and pharyngitis. She points out a smooth papule on his face that developed over the last few days. She says that he played with some kittens at a friend’s house about a week earlier, and she wonders if maybe he is extremely allergic to cats, because he has been rubbing his eyes ever since. View the image taken …
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Hip Pain in an 80-Year-Old Woman
Case An 80-year-old woman presents to an urgent care center with left hip pain that she has had for 4 years but that has worsened in the last week. She reports that before the pain worsened, she had gone on a long walk with her grandson. The pain is worse with movement through the range of motion. She has taken ibuprofen, but it did not reduce her pain. She says that she has not had …
Read MoreAbstracts in Urgent Care – December 2016
Sean M. McNeeley, MD Azithromycin May Not Be Helpful for Asthma Key point: There is no proven benefit from taking azithromycin for asthma. Citation: Johnston SL, Szigeti M, Cross M, et al; AZALEA Trial Team. Azithromycin for acute exacerbations of asthma: the AZALEA randomized clinical trial. JAMA Intern Med. 2016;176:1630–1637. The randomized, double-blind, placebo-controlled trial reported here focused on treatment for 3 days for 199 adults with asthma exacerbations. One group received 500 mg of …
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Original Research: HIV Screening in the Urgent Care Setting
Urgent message: Increasingly, Americans do not know their human immunodeficiency virus (HIV) serostatus. Implementing rapid HIV testing can allow your center to play a key role in identifying new cases of HIV and linking patients to care. Abstract Background: Data from the Centers for Disease Control and Prevention (CDC) suggest that an increasing number of Americans do not know their human immunodeficiency virus (HIV) serostatus. The CDC recommends routine screening for all patients 13 to …
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A 14-Year-Old with Vomiting and Bumps on the Tongue
In Bouncebacks, which appears periodically in JUCM, we provide the documentation of an actual patient encounter, discuss patient safety and risk-management principles, and then reveal the patient’s bounceback diagnosis. This case is from the book Bouncebacks! Pediatrics, by Michael B. Weinstock, Kevin M. Klauer, Madeline Matar Joseph, and Gregory L. Henry, and is available at www.anadem.com and www.amazon.com. Can you spot the red flags without knowing the outcome? Introduction Note: The following is the actual …
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Urgent Evaluation of Traumatic Neck Pain
Urgent message: Clinicians must be able to determine the cause and severity of injury in patients with neck pain, especially in the very young, whose symptoms vary according to their developmental status, and in the elderly, who have weaker bones and degenerative changes. Introduction Avariety of patients from children to the elderly will present to an urgent care Center with the chief symptom of neck pain. Cervical spine (C-spine) injuries occur in 3.7% of adults …
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