StuWilli, Author at Journal of Urgent Care Medicine

Managing Hypertensive Emergencies in the Urgent Care Setting

Urgent message: Health-care practitioners frequently see patients in urgent care centers who have elevated blood pressure. It is vital that they be able to identify hypertensive emergencies to immediately start lowering such patients’ blood pressure and then transfer them to an emergency department, to avoid hypertensive damage to the brain, heart, and kidneys. JON JUHASZ, MD Introduction Elevated blood pressure (BP) is very common in the urgent care setting, oftentimes from pain or from chronic …

Mixed Martial Arts Injuries

Urgent message: Because typical participants in mixed martial arts are young and healthy, many present to urgent care settings with a clear musculoskeletal injury and no other medical problems. Do not be distracted by the most obvious injury. Injuries from atypical mechanisms of injury are common in mixed martial arts and should be considered when evaluating a patient who has sustained injuries while participating in the sport. DEENA R. ZIMMERMAN, MD, MPH, IBCLC; NAHUM KOVALSKI, …

Fever Phobia: Urgent Fears in Urgent Care

Urgent message: Fear of fever leads many parents to seek urgent care. Addressing their fears should be part of the care of febrile children. DEENA R. ZIMMERMAN, MD, MPH, IBCLC; NAHUM KOVALSKI, MD; BARUCH HAIN, BA; and JOSHUA LIPSITZ, PHD In several studies, researchers have found that a large percentage of parents have fever phobia, or inaccurate beliefs about the harmfulness of an elevated body temperature. Those studies were conducted in primary-care settings, so we …

Improving the Patient Experience by Thinking Differently About Waiting

Urgent message: Attracting and retaining urgent care patients entails more than reducing the total duration of patient waits. It also requires understanding and managing patient expectations and perceptions of waiting. MICHAEL BURKE, MBA, and GARRETT BOMBA, MD People often respond irrationally in waiting situations. How else can we explain the fact that people are routinely more satisfied with a clearly explained 30-minute wait than with an uncertain 20-minute wait? It is not rational, but it …

Clinical Challenge: October, 2015

This feature will challenge your diagnostic acumen with a glimpse of x-rays, electrocardiograms, and photographs of conditions that real urgent care patients have presented with. If you would like to submit a case for consideration, please e-mail the relevant materials and presenting information to [email protected]. Case A 12-year-old presents with severe ankle pain and swelling after twisting an ankle while jumping off a tree limb. View the image taken (Figure 1) and consider what …

October 2015

Top 3 Blood Tests Performed at U.S. Urgent Care Centers in 2014

Data from the 2014 Urgent Care Chart Survey of 1,778,075 blinded visits by patients to more than 800 different urgent care clinics, conducted by the Journal of Urgent Care Medicine, reveal that the top 3 blood tests performed at U.S. urgent care centers in 2014 were as follows, in descending order: • Comprehensive metabolic panel—3.15 million tests • Glucose level—1.23 million tests • Thyroid-stimulating hormone level—1.19 million tests The survey’s methodology and data abstraction forms …

Open Fracture Treatment Versus Closed Fracture Treatment

Q. We had a patient come in with an open fracture of the distal interphalangeal joint of the right index and middle fingers, ICD-9 [International Classification of Diseases, 9th Revision, Clinical Modification] code 816.12. The provider set and splinted them both. Can I bill procedure code 26765 (“Open treatment of distal phalangeal fracture, finger or thumb, includes internal fixation, when performed, each”) twice? A. A diagnosis of open fracture means that the skin has been …

Blurred Vision and Painful Red Eye in a 40-Year-Old Patient

A 40-year-old man presents to an urgent care center with an acutely painful red eye in which he has blurred vision. He notices a bit of a headache and that there are some halos around lights, but he says that he has not experienced nausea or vomiting. When reviewing his medical history with you, he notes that he recently started taking a new antidepressant. View the image taken (Figure 1) and consider what your diagnosis …

Flashes of Light, Floaters, and Blurred Vision

A 70-year-old man presents with blurred vision and a nasal-field defect in one of his eyes. He reports that before arriving in the emergency department, he saw flashes of light and floaters, accompanied by a shower of black dots blocking his vision. Figure 1 shows what the physician sees when examining the patient’s eye with indirect ophthalmoscopy and scleral depression. Consider what your diagnosis would be.