THE CASE These x-rays were taken on a 49-year-old man with chronic bilateral knee pain that had increased over the past 6 months with ambulation. Examination was unremarkable. View the images taken (Figures 1, 2, and 3) and consider what your diagnosis would be.
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Nasal Polyps
Urgent message: Differential diagnosis and careful attention to signs, symptoms and history are particularly important in management of patients with nasal inflammation. MOHAMMED NOMAN MOHIUDDIN, MD Overview Nasal congestion and sinus symptoms are common urgent care complaints. Recurrent sinusitis, either from allergies or upper respiratory infections is frustrating to patients. Proper evaluation and treatment of underlying predisposing factors will help alleviate symptoms and address the disease process associated with polyps such as those seen in …
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Outpatient Management of Deep Venous Thrombosis
Urgent message: Urgent care providers are on the frontline in diagnosis of DVT. Outpatient management is a consideration for carefully selected patients. SABRINA SOOD, MD Deep venous thrombosis (DVT) is formation of a clot in the deep venous system, usually in a lower extremity. Half of untreated patients with DVT will go on to develop the fatal complication pulmonary embolism (PE). Approximately 300,000 to 600,000 Americans die each year due to venous thromboembolism (VTE).1 Urgent …
Read MoreRisk Mitigation in Urgent Care: Part 3
Lee A. Resnick, MD, FAAFP In my previous column, I discussed three core areas where risk and potential liability exposure lurk and ways to mitigate that risk. This month, the last in the three-part series, I will focus on specific clinical policies and procedures that can effectively reduce liability risk and enhance patient safety, quality and patient satisfaction…the holy grail of high-performing practices. Eliminating ‘Pre-triage’ The term “pre-triage” is used to describe the all-too-common practice …
Read MoreAbstracts in Urgent Care: May, 2014
Signs of aging and risk of heart disease Key point: Some outward signs of aging may correlate with increased risk of heart disease including MI. Citation: Christoffersen M, Frikke-Schmidt R, Schnohr P, et al. Visible age-related signs and risk of ischemic heart disease in the general population: A prospective cohort study. Circulation. 2014;4l128(9):990-998. Investigators in Denmark in this 35-year prospective trial attempted to see if outward signs of aging (frontoparietal baldness, crown top baldness, earlobe crease, …
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Acute Pericarditis
Urgent message: This case underscores the importance of not “anchoring” to a previous provider’s diagnosis and always remembering that medical conditions are dynamic. JOHN J. KOEHLER, MD, and DANIEL MURAUSKI, DO Introduction Acute pericarditis is defined as inflammation of the pericardium that surrounds the heart and the base of the great vessels. The classical presentation consists of chest pain, a pericardial friction rub, and serial changes on electrocardiogram (EKG). Although data on the incidence of …
Read MoreClinical Challenge – May 2014
THE CASE This patient presented with an ankle injury. View the image taken (Figure 1) and consider what your diagnosis would be.
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Evaluation of Headaches in Urgent Care Part 1: Emergent Headaches
Urgent message: Identifying potentially life-threatening or emergent causes of headaches can be challenging in urgent care. Emergent headaches are the focus of the first of a two-part series, aimed at aiding practitioners in appropriate evaluation and management. JACQUALINE DANCY, PA-C, MPAS Introduction The presentation of headaches in the urgent care setting often elicits some healthy angst. Differentiating between potentially life-threatening headaches and more benign varieties can be challenging, especially when the signs and symptoms are …
Read MoreRisk Mitigation in Urgent Care: Part 2
Lee A. Resnick, MD, FAAFP My previous column presented the building blocks of a risk mitigation framework for your practice. This column specifies high-risk areas of urgent care practice that create exposure for both owner and clinicians and suggests ways to mitigate that risk. Charting / Documentation: Your best defense when there is a bad outcome is documentation. The chart should clearly communicate your decision-making. The “standard of care” is not a guarantee against harm. …
Read MoreAbstracts in Urgent Care: April, 2014
Prompt Treatment of Pediatric UTI Prevents Renal Scarring Key point: To avoid renal scarring, don’t wait for urine culture in pediatric patients. Treat within 3 days. Citation: Coulthard MG, Lambert HJ, Vernon SJ, et al. Does prompt treatment of urinary tract infection in preschool children prevent renal scarring: Mixed retrospective and prospective audits. Arch Dis Child. 2013 Dec 18; [e-pub ahead of print]. Investigators in England looked at the relationship between time to treatment and …
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