Practice Management
Urgent message: When a child presents with periorbital cellulitis with no obvious cause, checking for intranasal foreign body, such as a button battery, is of paramount importance. Serious complications can be avoided if the foreign body is removed in a timely manner. MAY MOHTY, MD, FAAP, FAAUCM, and JACOB ANDERSON, DO Preseptal cellulitis, also known as periorbital cellulitis, is a relatively common diagnosis in the pediatric population. It is defined as infection of the space …
Read MoreThe Case The patient presented with painless hard masses on one lower leg. View the image taken (Figure 1) and consider what your diagnosis would be.
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Urgent message: Shoulder pain is not always “just another musculoskeletal complaint.” It may be referred pain indicating life-threatening conditions. Many patients use urgent care centers as sources of primary care. Thus when we make an important diagnosis because of our methodical, stepwise approach to examination, we have the opportunity to be the providers who ultimately expedite diagnosis and care for these patients. MIZUHO SPANGLER, DO, and MICHAEL B. WEINSTOCK, MD Shoulder pain is the third …
Read MoreSEAN M. McNEELEY, MD Sudden Death When Older Patients Taking Spironolactone Are Given Trimethoprim-Sulfamethoxazole Key point: Another drug interaction with potential deadly consequences. Citation: Antoniou T, Hollands S, Macdonald EM, et al; Canadian Drug Safety and Effectiveness Research Network. Trimethoprim-sulfamethoxazole and risk of sudden death among patients taking spironolactone. CMAJ. 2015;187:E138–143. It is known that the combination of trimethoprim-sulfamethoxazole (TMP-SMX) and spironolactone may increase potassium levels in patients. This study is very similar to one …
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Urgent message: Because pain in the lower abdomen is a symptom that can indicate many diseases, including acute appendicitis and acute diverticulitis, it is easy to misdiagnose epiploic appendagitis (EA). Thus, it is important that urgent care practitioners be able to distinguish EA from many other entities, especially because surgery presents the risk of complications. MAY MOHTY, MD, FAAP, FAAUCM, and ANDREW WANG, MS-3 An epiploic appendage is a fat-filled sac (1–2 cm thick and …
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Urgent message: Upper abdominal pain is a common presentation in urgent care practice. Narrowing the differential diagnosis is sometimes difficult. Understanding the pathophysiology of each disease is the key to making the correct diagnosis and providing the proper treatment. TRACEY Q. DAVIDOFF, MD Part 1 of this series focused on disorders of the stomach—gastritis and peptic ulcer disease—on the left side of the upper abdomen. This article focuses on the right side and center of …
Read MoreLee A. Resnick, MD, FAAFP In my last column I covered the 3 main causes of poor communication in transferring patients from urgent care centers to emergency departments (EDs). I discussed how poor communication creates risk, disrupts work flow, and erodes professional satisfaction. Poor interprofessional relationships and inadequate planning and structure are creating an environment ripe for these breakdowns. Reversing the trend requires a focus on rehabilitating relationships, initiating outreach, and developing coordinated policies and …
Read MoreThe Case The patient presented with an upper respiratory infection after vertebroplasty. A chest x-ray was ordered to rule out pneumonia. View the image taken (Figure 1) and consider what your diagnosis would be.
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Urgent message: Although chest pain in young adults is often benign, it is important to realize that emergency cases can sometimes be disguised as normal examination findings in adults. ZANA ALATTAR and JOHN SHUFELDT, MD, JD, MBA, FACEP This case demonstrates the importance of considering and ruling out rare cases of aortic dissection in patients with chest pain. We describe a case illustrating the approach to the management and work-up of chest pain in young …
Read MoreSEAN M. McNEELEY, MD The Return of Measles Key point: Measles is back, so watch for it among your patients. Citation: Centers for Disease Control and Prevention. Measles (rubeola). Atlanta, GA: Centers for Disease Control and Prevention [updated February 12, 2015; cited February 18, 2015]. Available from: http://www.cdc.gov/measles/hcp/index.html Unfortunately measles is making a comeback. Most likely because of decisions to delay or avoid immunizations, a measles outbreak began in California in December 2014 and has …
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