Credentialing has become a recurring nightmare for physicians of all specialties, in every state and in every practice setting. Eager for a fresh start, and energized by new opportunity, we decide to make a job change. Recruiters colorfully praise these openings, as if every job pays more than our current one, is closer to parks and culture, and exists in a region with a lower cost of living and, of course, better weather. After a …
Read More
Forearm Pain in a 12-Year-Old Patient After a Fall
A 12-year-old girl presents to an urgent care center with pain in her right forearm. She reports that the pain started the previous evening when she tripped on a toy left out by her 2-year-old brother. The pain is worse with range of motion. She says she does not have any numbness. She has no other injuries. View the image taken (Figure 1) and consider what your diagnosis would be.
Read MoreShoulder Injury During Football Game
An 11-year-old boy presents with pain over the right clavicle that developed the previous day while he was playing football and another player fell on him. He has pain with range of motion of the right shoulder as well as with movement of the torso. He has no shortness of breath, chest pain, dizziness, or numbness of the arm. View the image taken (Figure 1) and consider what your diagnosis would be.
Read MoreAbstracts in Urgent Care: January, 2016
SEAN M. McNEELEY, MD When Accuracy Is a Must, Go for Central Thermometers Key point: Peripheral thermometers are not nearly as accurate as central thermometers. Citation: Niven DJ, Gaudet JE, Laupland KB, et al. Accuracy of peripheral thermometers for estimating temperature: a systematic review and meta-analysis. Ann Intern Med. 2015; 163:768–777. Temperature measurement is performed at most visits to urgent care centers. Although the data are not always important in clinical decision-making, sometimes they are …
Read More
Sudden-Onset Severe Headache
Urgent message: Patients with imminently life-threatening conditions can present to an urgent care appearing to be in good health or even with a viable alternative explanation for their symptoms. It is important to be vigilant for red flags of serious illness. ARASH MIRZAIE, MS4, and MICHAEL WEINSTOCK, MD Headache is one of the most common presenting complaints in ambulatory settings. Urgent care providers must rapidly evaluate and diagnose a variety headache types in a time-limited …
Read More
Urgent Care Management of Acute Otitis Media in Children
Urgent message: The possibility of ear infection is the most common reason parents seek care for their young children during viral upper respiratory infections with fever. Urgent care providers should know the new criteria for making the clinical diagnosis and how to use technology such as an acoustic otoscope before concluding that antibiotics are necessary. MICHAEL E. PICHICHERO, MD Diagnosing acute otitis media (AOM) is a visual process based on viewing the eardrum and determining …
Read More
Urgent Care Diagnosis and Management of Tick-Borne Diseases
Urgent message: As the incidence of tick bites increases, it is imperative for urgent care physicians to be able to recognize various species of ticks and the symptoms of tick-borne illnesses and to know what to do when a patient presents with a tick bite. TOYIN FAPOHUNDA-ADEKOLA, MD, MBA Lyme disease is the most common tick-borne infection in the United States (Figure 1) and Europe. With a total of 279,509 cases reported between 2003 and …
Read MoreFrom Good to Great: A Guide for the Urgent Care Provider
It’s easy to think that all the steps we physicians and advanced practice providers must take before we are professionals make us great. After all, doesn’t everyone admire our impressive signature with its collection of professional certifications at the end? Not so fast. Greatness is not conferred or bestowed by degrees or certifications, and often it isn’t officially recognized. Instead, greatness is practiced, like yoga or karate. It is never a final achievement; it is …
Read More
Painful Defecation in a Child
An 8-year-old previously healthy boy with no history of skin disease presents with painful defecation and blood-streaked stools. He says that the perianal area does not itch. Physical examination findings are significant for well-defined perianal erythema and an anal fissure. View the image taken (Figure 1) and consider what your diagnosis would be.
Read More
Urgent Care Evaluation of Diarrhea
Urgent message: Diarrheal illness presents with varying degrees of severity and a broad range of etiologies. The urgent care center provider’s ability to gather key information from the medical history and physical examination, determine when laboratory testing is beneficial, and recognize indications for treatment is essential for the effective and efficient treatment of this common symptom. NATHAN M. FINNERTY, MD, and MICHAEL WEINSTOCK, MD Introduction Diarrheal illness is a common presenting complaint to all urgent care centers. In the United …
Read More