Common Lacerations of the Head
Urgent message: Effective management of head lacerations starts with hemorrhage control but also requires an understanding of appropriate use of anesthesia, the possibility of closed head or nerve injury, and vigilance for non-accidental trauma. Clayton Josephy, MD, Samuel M. Keim, MD, MS, and Paper Rosen, MD Introduction Laceration repair is a common and important responsibility of physicians in the emergency and urgent care settings. A recent review of national trends in ED visits revealed that …
Read More‘What to Expect When You’re Expecting’: The Birth of a Public Health Plan
With healthcare reform imminent, the question on everyone’s mind is: “How will this impact me?” While there is almost universal support for reform – what you might call the why of a healthcare fix – there is considerable disagreement about the how, when, who, and where. While the details of reform may change a bit over the next several months, there are a few things we should consider invariable: The Democrats’ solid control of the …
Read MoreJuly/August 2009
Proper Use of 99051, and the Status of S9088
Q. Can I bill the CPT code 99051 (Services(s) provided in office during regularly scheduled, weekend, or holiday office hours, in addition to basic service) for the purpose of getting a denial? Can I bill a Medicare patient for the 99051 code if I have an advanced beneficiary notice (ABN) completed? Anonymous, Texas A. This is a very interesting question, and I am sure it will generate significant controversy. In regard to your question about …
Read MoreDeveloping Data: July/August, 2009
In early 2008, UCA revamped its annual survey in conjunction with researchers at Massachusetts general Hospital and Harvard University with the goal of assuring that the UCA Benchmarking Committee’s efforts produced a scientifically valid report. Here we present some of the findings from this landmark survey, to which 436 urgent care centers responded. In this issue: How much time do patients spend in urgent care centers, on average? These data support – and, perhaps just …
Read MoreClinical Challenge: July/August, 2009
9-year-old girl has painful breathing after falling on chest
The patient is a 9-year-old girl who presents after experiencing a fall and a blow to her right chest. She complains of pain on deep breathing. On exam, you find a pulse of 103, and SAT of 96. She is not in respiratory distress; her chest exam is clear. She has an abrasion over her right chest. The patient is generally healthy, is on no medications, and has no significant past medical history. View the …
Read MoreThe Story of Jonathan— One Week in January
The Patient’s Perspective Jonathan is a young man who changed the course of musical theatre and would still be making history today if things had turned out differently. Jonathan was born in Mount Vernon, NY in 1960. When he was 22, he moved to New York City to pursue his dream of writing a musical. Like most struggling artists, life wasn’t easy. He spent weekends waiting tables at the Moondance Diner in Soho. He spent …
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Appendicitis Due to Squirrel Dinner
Introduction Appendicitis due to foreign bodies is a rare occurrence; most cases reported in the literature have occurred due to sharp objects such as pins, needles, toothpicks, and small nails. Solid foreign bodies – such as a bullet – rarely cause appendicitis. Appendicitis due to traumatic gunshot wounds has been described before, as have appendicitis cases due to ingested birdshot. Here, we describe an interesting case that demonstrates the importance of eliciting a history of …
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