Practice Management
As public health officials in California warn of a jump in reported cases of norovirus—also known as winter vomiting disease—across the state, a preholiday gathering in Seattle illustrates the speed with which the virus can wreak havoc in tightly packed events. The California Department of Public Health has confirmed 32 outbreaks that sickened hundreds between October and the end of 2015. Meanwhile, more than 200 people came down with symptoms of norovirus, which include abdominal …
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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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The patient, an otherwise healthy 2-1/2 year-old, experienced recurrent episodes of abdominal pain without vomiting or diarrhea. On exam, fullness of the abdomen was present. View the image taken and consider what your diagnosis and next steps would be. Click on the button below to see the resolution of the case.
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The patient is a young child with three days of constipation with a non-specific history of abdominal pain. On exam, the child is asleep. The abdomen is easily palpable and soft. Physical exam reveals no other remarkable factors. View the x-ray taken and consider what your diagnosis and next steps would be.
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Our goal with the Bouncebacks series is to maximize patient safety and minimize the urgent care provider’s medico-legal exposure. As Greg Henry wrote in the forward of our Bouncebacks! book, “The smart doctor is not the one who learns from his own mistakes. The smart doctor is the one who learns from the mistakes of others.” Our case this month involves a young man with vomiting and diarrhea and abdominal pain. This typical urgent care …
Read MoreOver the next few installments of this series, we will be discussing “bounceback” studies, and answering the following questions, in sequence: What is the incidence of bouncebacks? What is the incidence of bounceback admissions? What is the incidence of deaths in patients recently discharged from the ED? What percent of bouncebacks occur because of medical errors? How can we use this information to improve patient safety? Our feeling is that if we can use these …
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Urgent message: Noting ‘red flags’ specific to the individual patient is of key importance when details of the presentation do not add up. Jill Chavinson Miller, MD J.W. is a 55-year-old female non-smoker who presented with abdominal pain. She reported that the pain woke her up the night before and lasted all day long, which prevented her from doing much that day. She described the pain as constant and gnawing, assessing its severity as 6 …
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