Practice Management
Urgent message: The patient had two recent bee stings. Did they cause his problem or were they red herrings? PAUL BURES, DO, and LEE A. RESNICK, MD Introduction Hot, swollen, tender joints are a common initial complaint in the urgent care setting. Depending on the patient’s HPI and PMH, a definitive diagnosis can often be concluded. A systematic evaluation of infectious, inflammatory, and traumatic causes can help narrow the differential. Judicious use of the laboratory …
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Urgent message: When a test does not confirm a patient’s theory about the cause of her symptoms, both patient and provider must look elsewhere. SEAN MCNEELEY, MD Introduction When a mother of three complains of symptoms of pregnancy, the test usually confirms that she is right. Occasionally, however, the results are surprising, as this case illustrates. Case Presentation WM, a 28-year-old female, presented to an urgent care with concerns that she might be pregnant and …
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Urgent message: Prescribing Miralax and an enema would likely have killed this patient. He nearly died in the hospital. Can you figure out why? WILLIAM A. GLUCKMAN, DO, MBA, FACEP, CPE, CPC Constipation, a common urgent care complaint, can be a symptom of many things, not all of them obvious, and some life-threatening. In this tricky case, the underlying problem is one that many urgent care physicians would not consider in a differential diagnosis, yet …
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Urgent message: Although pancreatitis is a common cause of abdominal pain, many of its signs and symptoms are shared by other intraabdominal conditions. Most patients can be handled on an outpatient basis if diagnosis is accurate, as this case illustrates. MICHAEL TALKAR, MD Abdominal pain is a common and varied presentation in urgent care. A history and physical exam can be used to triage the majority of emergent cases. Strong communication is vital to ensuring …
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Urgent message: Evaluation of chest pain in the low-risk patient can be daunting. This case, in which the patient had no known history of cardiovascular disease, exemplifies the challenge. MARREN J. WEBER, DO The standard treadmill exercise tolerance test (ETT) and echocardiography are widely used as the initial tests of choice for prediction of cardiovascular disease. Historically stress echocardiography has been recognized to perform well in predicting mortality in conjunction with clinical data and other …
Read MoreUrgent message: Although free air in the mediastinum is generally a benign, self-limited condition, most patients should be admitted to the hospital and observed for signs of serious complications, which could be fatal. By Tracey Quail Davidoff, MD A previously healthy 17-year-old male presents to urgent care with a one-week complaint of sore throat, fever, and nasal congestion. On the last day, he had experienced sharp chest pain, which worsened with deep inspiration, swallowing, and …
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Urgent message: There is no diagnosis so “common” that it cannot be missed or mistaken for something else. A systematic approach to the history and examination are crucial to reaching the right conclusion and positive outcomes. Lee A. Resnick, MD Every now and then, medical school pearls are wrong. You remember: “When hearing hoof beats in Central Park, don’t go looking for zebras.” It may be true that zebras are infrequent visitors to New York …
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