Practice Management
Urgent message: Unusual as the diagnosis may be in 2009, patients with symptoms of what is later confirmed to be tetanus may be more likely to present to urgent care than to other practice settings. Curtis G. Kommer, MD, Latha Shankar, MD, and Mario Kapetsonis, MD Tetanus, a toxin-mediated infection of gram-positive bacteria Clostridium tetani, is a rare presentation in the 21st century. Since 2000, there have been fewer than 50 cases per year reported …
Read MoreThis patient, a 34-year-old male whose pre and post-reduction x-rays are shown here (Figure 1 and Figure 2), presented to urgent care after sustaining an axial injury to his fourth left finger while playing a weekend game of football. FIGURE 1. PRE-REDUCTION Reduction proved physically chal- lenging to more than one practi- tioner. A physician who happened to be on site tried unsuccessfully to reduce the dislocation at the time it occurred, then recommended the …
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Urgent message: Injuries sustained in playground falls are common presentations to emergency departments and urgent care centers alike. The urgent care physician should be alert to the keys to evaluation and management of traumatic neck pain. Muhammad Waseem, MD, Lalithambal Venugopalan, MD, and Gerard Devas, MD Cervical spine (C-spine) injuries occur infrequently in children. This is especially true for fractures of atlas vertebra, which is a rare injury in children. Its diagnosis may easily be …
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Urgent message: Atypical chest pain in a young male offers a challenge solved by ordering—and assessment—of the appropriate imaging. Shannon Dowler, MD The patient is a 20-year-old white male who presented to urgent care with a two-week history of mild dyspnea, with the onset of chest pain in the prior 24 hours. He denied wheezing, vomiting, and recent trauma, and reported that he has tried no medications for his symptoms. Further discussion with the patient …
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Urgent message: Ectopic pregnancy must be considered in women of childbearing age who present with abdominal pain—even if ‘ruled out’ by a negative hCG test. Yi-An A. Lee, MD, MPH, Gino Farina, MD, and Helene Lhamon, MD The incidence of ectopic pregnancy is estimated to be 19.7 per 1,000 pregnancies and is responsible for 9% of pregnancy-related deaths.1 Ectopic pregnancy is always near the top of the differential diagnosis for abdominal pain in women of …
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Urgent message: Clinicians must be prepared for the possibility of supraventricular tachycardia after administration of nebulized albuterol in patients of any age, especially in the presence of heart disease. Muhammad Waseem, MD, Padma Gadde, MD, and Gerard Devas, MD Asthma is the most common lung disease in children. Five percent of children in the United States have asthma, and status asthmaticus—the leading cause of admission due to asthma exacerbation—accounts for approximately 10% of visits to …
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Urgent message: Noting ‘red flags’ specific to the individual patient is of key importance when details of the presentation do not add up. Jill Chavinson Miller, MD J.W. is a 55-year-old female non-smoker who presented with abdominal pain. She reported that the pain woke her up the night before and lasted all day long, which prevented her from doing much that day. She described the pain as constant and gnawing, assessing its severity as 6 …
Read MoreM.J. is a 12-year-old African American female who presented with trouble “taking a breath” which was abrupt in onset, starting two hours prior to presenting and accompanied with abdominal pain and fatigue which resolved prior to her visit. Dyspnea was constant and not related to position. There were no alleviating or aggravating factors. Observations and Findings Patient was alert and in no distress and spoke in full sentences. Pmhx: bronchitis one year prior; no asthma, …
Read MoreMr. J.V. is a 28-year-old white male who presented to urgent are with a six-hour history of chest pain described as pressure in the sternal area radiating to the left shoulder; back pain was a 5/10 at time of visit, and constant with no accompanying nausea, dizziness, vomiting, or diaphoresis. The patient described an inability to breathe deeply and a sensation of water stuck in the mid esophagus when drinking. Of note, he had similar …
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