Practice Management
A 62-year-old man presents with right shoulder pain that began the previous evening after he fell in his garage. The pain is worse with movement through the range of motion. He has no pain in the elbow and says that he has no head pain or head injury. His social history reveals that he is a smoker and drinks alcohol. View the image taken (Figure 1) and consider what your diagnosis would be.
Read MoreSEAN M. McNEELEY, MD Copeptin and Troponin Together Are Useful in Diagnosing Acute Coronary Syndromes Key point: There is a new tool for ruling out myocardial infarction. Citation: Ricci F, Di Scala R, Massacesi C, et al. Ultra-sensitive copeptin and cardiac troponin in diagnosing non-ST-segment elevation acute coronary syndromes—the COPACS Study. Am J Med. 2016;129:105–114. Concern about patients with non-ST-segment elevation myocardial infarction with chest pain and normal electrocardiogram (ECG) findings frequently causes a transfer …
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Urgent message: Proptosis may be caused by a variety of vascular, infectious, endocrine, and neoplastic diseases that may threaten vision or cause serious systemic complications or death. Providers should be familiar with causes and work-up, including which findings suggest a need for immediate imaging and consultation. ARMIN GOLLOGLY, MD, BRIAN ZIPSER, MD, WENDY HUANG, MD, FAAO, FAAP, CHRISTOPHER M. FECAROTTA, MD, FAAO, FAAP, FCPP, AND MARK RICHMAN, MD, MPH Introduction This report describes a case of unilateral proptosis due to …
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Urgent message: Evaluating patients with acute scrotal pain can be a challenge for clinicians in the outpatient setting because several conditions indicated by it can cause significant morbidity. Performing a thorough but focused medical history and physical examination and considering certain diagnoses, including testicular torsion, epididymitis, and prostatitis, are imperative when assessing these patients. JEREMY HAWKINS, MD, BRIT LONG, MD, and ALEX KOYFMAN, MD, FAAEM Introduction Evaluation of acute scrotal pain is often challenging for clinicians …
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A 36-year-old man comes to an urgent care center reporting pain in his back that began the previous day. The pain is sharp and worse with certain changes in position. He does a lot of lifting at his job stocking shelves in a grocery store, but he cannot relate the onset of the pain to any specific lifting that he has done. View the image taken (Figure 1) and consider what your diagnosis would be.
Read MoreSEAN M. McNEELEY, MD Inhaled Steroids Do Not Reduce Growth in Children with Asthma Key point: Inhaled steroids did not reduce growth velocity in a 1-year study. Citation: Wardenier NR, Klok T, de Groot EP, Brand PL. Height growth in children with asthma treated with guidelinerecommended dosages of fluticasone and electronically assessed adherence. Arch Dis Child. 2015 December 7. doi: 10.1136/archdischild-2015-309654. Adherence to therapy is important for children with asthma. Many factors, including fear of …
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Urgent message: It is important for urgent care providers to be able to recognize the lesser-known arthritides as causes of acute joint pain and to recognize their specific manifestations on x-rays. Further work-up is warranted because some of these diseases can be associated with various metabolic disorders. MAY MOHTY, MD, FAAP, FAAUCM, and HAMILTON WHITE, MS4 Introduction The deposition of calcium pyrophosphate dihydrate crystals in and around joints is called CPPD (calcium pyrophosphate dihydrate deposition) disease. This condition manifests in a variety …
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Urgent message: The clinical manifestations of Zika virus infection are generally mild in adults; the primary concern is the potential link to microcephaly in children of infected pregnant women. There is no cure, so prevention is paramount. MIZUHO SPANGLER, DO, and MICHAEL B. WEINSTOCK, MD Introduction The Zika virus epidemic is gaining a lot of media attention, deservedly so; there have been large outbreaks of infection in Brazil, South America, and the Caribbean, with numbers …
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Urgent message: Acute ankle injuries can progress to chronic issues. It is essential that the urgent care clinician be aware of the mechanisms of common ankle injuries, their pathophysiology, essential diagnostic tests, and which injuries require transfer for a higher level of care. LISA SCHUERMAN, RN, MSN, APNP Introduction The ankle is one of the most common sites for acute musculoskeletal injuries, with sprains accounting for 75% of ankle injuries. The ankle joint is composed of the tibia, fibula, and talus. …
Read MoreIt seems like metrics and analytics are the buzzwords to watch in 2016. Everyone— from health-care administrators to carwash operators—is looking for ways to measure best practices, key business drivers, and employee performance to stand out. Even my beloved Cleveland Browns became the first team in professional football to hire a chief strategy officer to apply analytics in picking players who give the team its best chance of winning. Health care itself is into analytics, …
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