Practice Management
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 59-year-old male with a past medical history of hypertension presents with dyspnea and pleuritic chest pain in urgent care, and an ECG is obtained. View the ECG captured below and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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A 25-year-old man undergoing chemotherapy with cyclophosphamide, vincristine, doxorubicin, and dexamethasone for acute lymphoblastic leukemia arrives in urgent care because he’s developed a painful, burning palmar eruption. On examination, tender, shiny, erythematous papules and plaques were seen on the palms and fingers as well as the soles of his feet. View the image above and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page.
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Urgent Message: Proximal humerus fractures most commonly occur in older patients after a fall and can be sentinel events that offer an opportunity to identify undiagnosed medical conditions or unsafe home environments. Lauren Schuermann, MS4; Shivani Kothari, MS4; W. Bradley Strauch, MD Citation: Schuermann L, Kothari S, Strauch B. Urgent Care Recognition and Management of Proximal Humerus Fractures. J Urgent Care Med. 2024; 19(2): 13-19 Questions for the Clinician at the Bedside Clinical Scenario A …
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Urgent Message: Urethral obstruction can occur due to impacted urinary calculi. This etiology should be considered in patients with known or suspected history of kidney stones who present with urinary retention. Point-of-care ultrasound can be used to evaluate for and confirm this diagnosis in male patients, in whom the phenomenon is most likely. Nicholas Maenza, DO; Jeffrey Darko, MD Citation: Maenza N, Darko J. Urinary Retention Caused by a Urethral Stone Diagnosed with Point-of-Care Ultrasound: …
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Urgent Message: There are no consensus definitions for what defines a “positive” urinalysis in the pediatric population. This secondary analysis of data from a quality improvement project in a network of pediatric urgent care centers used a machine learning approach to determine which variables on urinalysis most strongly predict a subsequently positive urine culture. Kari Flicker, BS; Jessica Parrott, DNP, CPNP-PC, CNE; Tammy Speerhas, DNP, FNP-C; Turaj Vazifedan, DHSc; Theresa Guins, MD; Jeffrey Bobrowitz, MD; …
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Urgent Message: Incorporating questions regarding the use of intravenous drugs may help ensure the diagnosis of puffy hand syndrome is included in the differential for patients presenting with bilateral hand swelling. Citation: Majeed I, VanDyke K. Puffy Hand Syndrome: A Case Report. J Urgent Care Med. 2024; 19 (2): 25-27 Abstract Introduction: Bilateral hand swelling is a common presentation in a variety of conditions, particularly rheumatological disorders. Urgent care (UC) providers can avoid unnecessary testing …
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Sophistication of ECG for Detection of Acute Coronary Syndromes Take Home Point: Cardiac electrical biomarker (CEB), a finding detectable on ECG, may hold potential for identifying patients with acute myocardial ischemia; this may have significant implications for urgent care (UC) based chest pain risk stratification. Citation: Chattopadhyay S, Adjei F, Kardos A. Changes in Cardiac Electrical Biomarker in Response to Coronary Arterial Occlusion: An Experimental Observation. J Cardiovasc Transl Res. 2024 Aug;17(4):870-878. doi: 10.1007/s12265-024-10487-w. Relevance: …
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Urgent Message: Fractures of the distal radius, commonly referred to as Colles fractures, most often occur after a fall onto an outstretched hand. Their immediate urgent care management may require only splinting or a same day emergency department visit depending on certain factors. Citation: Bunstine JL, Hartz C. Urgent Care Diagnosis and Management of Distal Radial (Colles) Fractures. J Urgent Care Med. 2024; 19(1):15-19 Editor’s Note: While the images presented here are authentic, the patient …
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Public Perceptions of Artificial Intelligence Use in Healthcare Take Home Point: Patient and healthcare workers surveyed were generally accepting of the use of artificial intelligence (AI) in medicine. Respondents did express some concern about the potential impact of AI on the accuracy of medical decision-making, however. Citation: Thornton N, Binesmael A, Horton T, et al. AI in health care: what do the public and NHS staff think? The Health Foundation. Published July 31, 2024. Accessed …
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