Practice Management
An 11-year-old male presents to urgent care complaining of bilateral heel pain, right worse than left. The patient denies recent trauma and reports experiencing increased pain when running. He has not tried any treatment and denies any history of similar episodes in the past. Physical examination reveals bilateral pes planus and decreased dorsiflexion of the feet with weightbearing lunge against the wall. Pain is elicited with calcaneal compression test. The patient is noted to be …
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Urgent Message: Rapid identification of Lisfranc injuries in urgent care is critical, as delays in diagnosis can lead to chronic disability. Most patients with Lisfranc fractures or dislocations should be referred directly to the emergency department. Cross-sectional imaging (ie, computed tomography) and orthopedic consultation are time-sensitive, and urgent operative repair is often indicated. Alexandra Eby, BS; Nicole Meschbach, MD Questions for the Urgent Care Clinician at the Bedside Abstract A Lisfranc injury is a tarsometatarsal …
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A 51-year-old man presents to urgent care complaining of night sweats and a productive cough with visible blood for the past 2 weeks. He says he’s been feeling rather tired lately. A chest x-ray is ordered. Review the image and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page.
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Most of the legislative issues that affect urgent care operations are governed at the state level, particularly provider scope-of-practice laws. A recent guest column in the Columbus Dispatch by Alan Ayers, MBA, MAcc, President of Urgent Care Consultants and Senior Editor of JUCM, makes the case for urgent care’s untapped potential in providing affordable access to care in rural areas. Kentucky and Indiana are witnessing growth in rural urgent care, but Ohio is lagging because …
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A 7-year-old boy presents to urgent care with his worried mother after he fell off a swing at daycare. He is complaining of right foot pain and can’t walk on the injured foot. Anterior posterior and oblique foot x-rays are ordered. Review the image and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page.
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ECG Interpretation: Humans Vs Machines Take Home Point: In this study, cardiologists and emergency physicians (EP) had greater accuracy for electrocardiogram (ECG) interpretation than current versions of ChatGPT and Gemini. Citation: Günay S, Öztürk A, Yiğit Y. The accuracy of Gemini, GPT-4, and GPT-4o in ECG analysis: A comparison with cardiologists and emergency medicine specialists. Am J Emerg Med. 2024 Oct:84:68-73. doi: 10.1016/j.ajem.2024.07.043. Relevance: Artificial Intelligence (AI) is rapidly evolving and becoming an integral part …
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Urgent Message: Fractures of the midshaft ulna, commonly referred to as “nightstick fractures,” typically occur after direct injury to a forearm outstretched above the head as a protective mechanism. Evaluation includes inquiry into the circumstances of the assault, assessment for any other areas of trauma, examination of the skin, wrist and elbow joints, and radiography of the forearm. Management of closed, nondisplaced midshaft ulnar fractures centers around splint immobilization and arrangement of appropriate follow-up. Chandrika …
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A 55-year-old woman presents to urgent care complaining of pain when she moves her right wrist. She reports the pain began suddenly when she woke up that morning without any known trauma. An x-ray is ordered. Review the image and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page.
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A 30-year-old woman presents to urgent care with pain in her lower back and pelvis. She denies any injury or accident that might be causing her pain. She has just returned to full-time work after having a baby. An x-ray is ordered. Review the image and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page.
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A 29-year-old man presents to urgent care complaining of chronic right hip pain with movement and exercise. He’s an avid mountain climber and used to play sports in college. Review the images and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page.
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