Practice Management
Urgent message: Metacarpophalangeal dislocations involving digits other than the thumb or index finger may be somewhat atypical, but are known to occur as a result of a fall on an outstretched hand—a common precedent to an urgent care visit. Familiarity with management of such injuries precludes the need to refer the patient. Leonard A. Powell, DO, MS, FACOFP, CMD and Chad E. Richmond, DO ABSTRACT Metacarpophalangeal (MCP) joint dislocations typically occur in a dorsal fashion …
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Urgent message: The angle of the mandible is one of the most common locations among bilateral mandibular fractures. Bilateral mandibular angle fractures are a rare traumatic event and often occur in the setting of panfacial fractures due to an impacting force. Chad E. Richmond, DO, DAOBFP; Leonard Powell, DO, MS, FACOFP, CMD; Keith S. Richmond, DMD, MDS. INTRODUCTION The mandibular angle is a weak zone that is more exposed to fractures than other areas of …
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Urgent message: Remain diligent in the evaluation of headache; though often a benign condition, the possibility for severe morbidity and mortality warrants careful evaluation of subtle aspects within the history and/or physical exam. INTRODUCTION Headache is one of the most common complaints in the urgent care setting, yet also one that can be daunting for a provider. While there are many benign causes, such as a migraine or tension headache, the potential for an emergent …
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Urgent message: Previously undiagnosed diabetes in elderly patients is too frequently a precursor to the diagnosis of pancreatic cancer. Incidental and unexpected diagnosis of diabetes in older patients in urgent care, especially in normal or underweight individuals, should prompt a discussion about vigilant monitoring for other symptoms of malignancy and close follow-up with a primary care provider. Joshua Russell, MD, MSc, FCUCM, FACEP CASE PRESENTATION A 72-year-old woman with a history of hypertension presented to …
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Urgent message: Urgent care providers need to be vigilant for more than acute coronary syndrome, pulmonary embolism, and thoracic aortic dissection when patients present with chest pain—such as this 20-year-old who developed pneumomediastinum while smoking marijuana. Xiangyang Jiao, MD Case Presentation A 20-year-old female presented to urgent care for pleuritic chest pain and shortness of breath for about 2 hours. The chest pain was located in the upper and mid chest, was dull, pressure like, …
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Urgent message: The differential diagnosis for unilateral testicular pain includes testicular torsion; this is a ”must not miss” diagnosis, as delayed diagnosis can cause significant morbidity both physically and psychologically. Jeannette Vaughn-Dotterer, PA-C CASE PRESENTATION ML is a 47-year-old male who developed left-sided testicular pain after getting out of bed 2 hours prior. He states that his left testicle appears to be “dancing” and seems to be riding higher than his right testicle. ML states …
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Urgent message: Patients present to urgent care with a variety of complaints, many of which are common—even if they are the result of an uncommon condition. It is important that the provider develop a broad differential diagnosis as they approach these problems. Richard A Ginnetti, MD, MBA, CPE and Justin Holschbach, MD CASE PRESENTATION History A 52-year-old male presents to urgent care with the chief complaint of new lower posterior neck and right shoulder pain …
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Urgent message: Acute or chronic hallux pain is a common complaint in urgent care. Due to the structure, several diagnoses can have similar presentation on history and exam. With this discussion, we examine a sesamoid stress injury. Sergio P. Ramoa, MD, MS INTRODUCTION The tibial (medial) and fibular (lateral) sesamoids are contained within the flexor hallucis brevis tendons along the metatarsal head.1 They have several roles such as absorbing weight, helping glide and reducing friction …
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Urgent message: Cutaneous abscesses are common presentations in urgent care. While either methicillin-sensitive or methicillin-resistant Staphylococcus aureus accounts for up to 75% of skin abscesses, atypical organisms such as nontuberculous mycobacteria (NTMB) can also lead to abscess formation. Urgent care providers should be aware that the clinical presentation may be atypical and require specialized treatment. Rachel Hughes, MD and Erik Butler, DO CASE PRESENTATION A 26-year-old female with no known past medical history other than …
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Urgent message: Pulmonary eosinophilia is a generic term for a heterogeneous group of disorders that result in increased eosinophils within the pulmonary parenchyma. Ultimately, the patient here was treated with an extended course of glucocorticoids to treat his chronic eosinophilic pneumonia until he could follow up with his hematologist/pulmonologist. CASE PRESENTATION The patient is a 29-year-old male with history of pulmonary eosinophilia, degenerative disc disease, and asthma who presents to an urgent care center with …
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