Practice Management
Urgent message: The differential diagnosis of neck pain is broad. A systematic and effective approach is required to rule out life-threatening conditions. RANIER NG, DO, and MICHAEL ROWANE, DO, MS, FAAFP, FAAO Neck pain is a frequently encountered complaint in urgent care. About two-thirds of the population will experience neck pain at some point in their lives.1 Many patients experience a sense of debilitation with every movement of their neck. Patients may perceive neck pain …
Read MoreRisk Factors for Clinical Failure in Cellulitis and Skin Abscess Key point: Hospitalized patients with obesity may experience clinical failure because of inadequate antibiotic dosing. Citation: Halilovic J, Heintz BH, Brown K. Risk factors for clinical failure in patients hospitalized with cellulitis and cutaneous abscess. J Infect. 2012; 65(2): 128-134. Although most individuals with cellulitis or skin abscess are managed as outpatients, hospital admission is sometimes necessary. Several risk factors for hospitalization have been identified. …
Read MoreThe patient, a 3-year-ld male, suffered a blow to his left wrist. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is described on the next page.
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Urgent message: Infectious flexor tenosynovitis is an orthopedic emergency that can cause long-lasting disability through tendon necrosis and permanent digital contracture if unrecognized or mismanaged. MARY A. LANE, MD Flexor tenosynovitis is an inflammation of the tendon sheath that can be caused by either introduction of infection or various inflammatory conditions ranging from autoimmune arthropathies to crystal joint depositions. Flexor tenosynovitis caused by infection is an orthopedic emergency. It can cause long-lasting disability through tendon …
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Urgent message: Infants who cry excessively pose a challenge to physicians and parents. A systematic approach to the history and physical exam can guide the diagnostic approaches to determine if a benign – or serious – condition is responsible. Toni Clare Hogencamp, MD Crying is a primitive form of communication that infants rely on to communicate their distress. Because infants cannot verbalize their discomfort, they must rely on their cry to communicate with caregivers. Estimates …
Read MoreLee A. Resnick, MD, FAAFP In my last column I examined the recent study by the Center for Studying Health System Change which reviewed data from the 2008 National Hospital Ambulatory Medical Care Survey (NHAMCS). I identified critical flaws in the definitions used to distinguish “appropriate” emergency department (ED) visits from “non-urgent” or so-called “routine” visits. I concluded that the study missed a tremendous opportunity to identify alternatives for the vast majority of patients with …
Read MoreThe patient, a 2-year-old girl, suffered a blow to her right knee and could not bear weight on her right leg. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is described on the next page.
Read MoreAge-based cutoffs for D-dimer levels Key point: Age-based cutoffs for D-dimer levels can more accurately rule out deep venous thrombosis than the conventional cutoff level. Citation: Schouten HJ, Koek HL, Oudega R, et al. BMJ. 2012; 344: e2985. Researchers measured D-dimer values in some 650 patients suspected of having deep venous thrombosis but who had a low clinical probability according to their Wells score. Compression ultrasonography was used to confirm the diagnosis. Various cutoff levels …
Read MoreThe patient, a 72-year-old male, had local swelling in his right elbow. He had no history of trauma but he did suffer from dementia. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case if described on the next page.
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Urgent message: Always be mindful of the ‘zebra’ in a stampede of ‘horses’ in the differential diagnosis. ELISABETH L. SCHEUFELE, MD, MS, FAAP Case Presentation J.H. is a 19-year-old Hispanic male presenting with abdominal pain and shortness of breath for the last 4 days. He had visited the urgent care clinic about 2 days before with similar symptoms and was discharged with a diagnosis of muscle strain. J.H. returned with persistent symptoms and he indicates …
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