This 16-year-old patient presented with a blow to the left wrist. View the image taken and consider what your diagnosis would be.
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July/August 2011
Abstracts in Urgent Care: July/August, 2011
Heparin-Binding Protein: A New Biomarker for Bacterial Meningitis Key point: A cerebrospinal fluid HBP level >20 ng/mL was 100% sensitive and 99.2% specific for bacterial meningitis in adults. Citation: Linder A, Akesson P, Studahl M, et al. Heparin- binding protein: a diagnostic marker of acute bacterial meningitis. Crit Care Med. 2011;39(4):812-817. To assess whether cerebrospinal fluid (CSF) levels of heparin- binding protein (HBP) can predict bacterial meningitis, re- searchers analyzed CSF samples in a prospective …
Read MoreDeveloping Data: July/August, 2011
In each issue on this page, we report on research from or relevant to the emerging urgent care marketplace. This month, we offer a look at data from the 2010 Urgent Care Benchmarking Survey Results. These data are based on responses of 1,691 US urgent care centers; 32% were UCA members. The survey was limited to “full-fledged urgent care centers,” the qualifications for which included accepting walk-ins during all hours of operation, as well as …
Read MoreCan an Urgent Care Use an ED E/M Code and Three Other Coding Challenges
DAVID STERN, MD (Practice Velocity) Q.Can 99283 and 99214 procedure codes be used for an urgent care visit? The codes were used by an urgent care facility, and I am told that 99283 is categorized as an emergency room code. A.Code 99283 is for an emergency department visit for the evaluation and management of a new or established patient with an expanded problem focused history and examination and medical decision making of moderate complexity. Code 99214 …
Read MoreHow to Get Sued for Malpractice: Four Studies In Self-Destruction
JOHN SHUFELDT, MD, JD, MBA, FACEP In the past, I have written about how to avoid getting named in a medical malpractice action. But it can often be instructive to view things from the opposite perspective. So this time, let’s turn it around and actually try to get named in a malpractice suit. It usually only takes one of the following misadventures: Practice bad medicine and have a bad outcome Practice good medicine, communicate/document poorly, …
Read MoreClinical Challenge: July/August, 2011
The patient is a 37-year-old female who presents with a history of long-standing hypertension and diabetes mellitus. She had recently started on a new diuretic and felt very weak and light-headed. Her blood pressure was 88/56 mmHg with a pulse of 44 beats per minute. View the patient’s ECG (Figure 1). Consider the type of diuretic is she likely to be taking and what your next steps would be. Resolution of the case is described …
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Dealing with the Disruptive Doctor
Urgent message: When a physician is dubbed “Tom the Terror,” turning a blind eye can send patients and staff heading for the exit, wreck your reputation, and spark a lawsuit. Here’s what to do instead.LEONARD D. GOODSTEIN, PHD, ABPP, and JOHN SHUFELDT, MD, JD, MBA, FACEP Tom P. is a competent, board-certified emergency physician. He is liked and respected by his patients. But Tom‘s relationships with staffers at the urgent care center where he still …
Read MoreAcute Stridor in Children
Urgent message: Acute stridor in pediatric patients is alarming to children, parents, and healthcare providers alike. Differential diagnosis is the key to initial evaluation and management of this worrisome symptom. Here is how to think it through. JERRI A. ROSE, MD, FAAP Stridor is an externally audible sound caused by abnormal air passage during breathing.1 It results from turbulent airflow through large airways. When a normal respiratory volume of air passes through narrowed airways, the …
Read MoreOur Infected Food Chain: Lessons from Groundhog Day
Lee A. Resnick, MD, FAAFP An E. coli outbreak, believed to have originated from a crop of bean sprouts in Northern Germany, has killed at least 36 people across Europe. Watching the public health “crisis” unfold, I can’t help but think of the 1993 comedy “Groundhog Day.” Phil Connors (Bill Murray), an egotistical meteorologist from Pittsburgh tasked with covering the annual Groundhog Day in Punxsutawney, Pennsylvania, finds himself caught in a time warp in which …
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