Practice Management
Urgent message: Undiagnosed type 2 diabetes mellitus affects more than 9 million Americans. This first part of a two-part article focuses on evaluation of diabetes screening for the adult urgent care patient in whom diabetes has not been diagnosed, using effective early disease-detection strategies to reduce the long-term burden of diabetes. How this article helps you: by providing data to assist you in deciding about screening in your center. Introduction There are now more than …
Read MoreIn my last column, I presented ways that urgent care medicine can mature as a discipline and a health-care service. I discussed opportunities for expanding our value in a changing system. This month I suggest that one such opportunity, already in the pipeline, could dynamically augment urgent care’s role in what many consider to be the number one public health crisis: type 2 diabetes. The annual incidence of prediabetes and diabetes in U.S. adults is …
Read MoreSEAN M. McNEELEY, MD Dexamethasone May Be Worthwhile in Treating Adult Asthma Key point: Dexamethasone is almost as good as prednisone in treating asthma in adults. Citation: Rehrer MW, Liu B, Rodriguez M, et al. A randomized controlled noninferiority trial of single dose of oral dexa- methasone versus 5 days of oral prednisone in acute adult asthma. Ann Emerg Med. 2016 April 22. doi: 10.1016/ j.annemergmed.2016.03.017. [Epub ahead of print.] In a randomized placebo-controlled trial …
Read More
Case An 8-year-old boy presents to an urgent care center with left knee pain that he has had for 3 days. The pain is worse with walking, and his mother says that he has been limping and will not put full weight on the leg. He reports no trauma, fever, vomiting, or numbness. His mother reports that she has given him ibuprofen but that this has not relieved his pain. View the image taken (Figure …
Read More
A 46-year-old weekend warrior presents to an urgent care center 3 hours after injuring his right ankle and foot while playing basketball. He reports moderate to severe pain over the lateral side of the ankle and foot, which started after he jumped for a rebound and came down on the foot while it was in plantar flexion and inverted. However, he can walk. He reports no paresthesia or pain at the midfoot or proximal fibula, …
Read More
Urgent message: Though the cause of nonspecific numbness and tingling will often be benign, serious illnesses should be included in the differential diagnosis. Introduction Many patients at urgent care centers present with numbness and tingling. The symptoms can be caused by variety of underlying benign or potentially malignant pathologies. The medical history and physical examination play a central role in the determination of the cause of numbness. Numbness that is limited to a part of a limb suggests mononeuropathy, whereas numbness that involves most …
Read More
Urgent message: The etiology of nonhealing wounds is often multifactorial, with the likelihood of healing enhanced if all considerations are addressed, including evaluation and management of the blood supply in patients with peripheral arterial disease or diabetes mellitus, as well as local wound care. The diagnosis of a nonhealing wound is largely clinical, with diagnostic studies tailored to the suspected cause as well as to the underlying process. Part 1 of this article [see “Nonhealing Wounds, Part 1: Diagnosis in the Urgent Care …
Read More
A 38-year-old man presents to an urgent care center and reports pain in his right heel and ankle that he describes as severe enough that he cannot walk on the foot. He says that the pain began the previous evening when he landed on the group after jumping out of a second-floor window on a dare. He has some minimal paresthesia, but he has no fever, vomiting, head trauma, head or neck pain, or chest …
Read More
A 67-year-old woman presents to an urgent care center after 12 hours of pain in her right hip that began after she slipped in her kitchen and fell onto that hip. She reports that the pain is constant and worsens with walking. She has not experienced numbness in the hip, and she reports no other injuries. She has not sustained any head trauma, and she has no head or neck pain. View the image taken …
Read MoreSEAN M. McNEELEY, MD Longer-Term Antibiotic Treatment and Persistent Lyme Disease Symptoms Key point: Longer therapy for Lyme disease is not helpful. Citation: Berende A, ter Hofstede HJ, Vos FJ, et al. Randomized trial of longer-term therapy for symptoms attributed to Lyme disease. N Engl J Med. 2016;374:1209–1220. Lyme disease continues to be in the news because persistent symptoms after infection are of great concern. In a double- blind, placebo-controlled study, researchers gave antibiotics for …
Read More