Practice Management
The patient is a 35-year-old male with a soft tissue mass in the mid index finger of his right hand. He reports that he noticed it only recently, and denies any other symptoms. View the x-ray taken and consider what your diagnosis and next steps would be.
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Urgent message: Psoas (or iliopsoas) abscess, although rare, is a cause of back pain associated with high morbidity and mortality. Proper diagnosis requires the physician to recognize signs in the history and physical examination that are suggestive of a potentially serious spinal condition prompting further workup. Fabrizia Faustinella, MD, PhD and L. Alexandre Frigini, MD Citation: Faustinella F, Frigini LA. A common compliant with an unlikely diagnosis: psoas abscess in the urgent care center. J …
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Urgent message: Often, patients that could safely be treated for lacerations in the urgent care center are referred to the emergency room due to the quest for expediency, or even providers being out of practice with treating such wounds on site during the COVID-19 pandemic. However, doing so contributes to the degradation of acuity in urgent care while delaying care and raising costs. Anesthesia for wound repair can be achieved in many ways, typically with …
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Urgent message: Utilization of validated scoring systems and clinical decision-making tools can enable the urgent care provider to manage many patients presenting with symptoms of deep-vein thrombosis in the urgent care center, reducing the need for costly referral to the emergency room. Daniel Eisner, DMSc, PA-C ABSTRACT Management of venous thromboembolism accounts for $10 billion in medical spending annually, with much of the cost attributable to emergency room visits. Conversely, managing VTE patients in the …
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Ivan Koay MBChB, MRCS, FRNZCUC, MD Kinesiology Taping for Shoulder and Chest Wall Injuries Take-home point: Kinesiologytaping (KT) combined with standard care appears to be more effective for acute pain reduction in patients with uncomplicated traumatic injury of the shoulder or chest wall. Citation: Bakker M, Bon V, Hubrechts B, et al. Kinesiotaping for acute pain due to uncomplicated traumatic injury of the shoulder or chest wall. Am J Emerg Med. 2022;58:197-202. Relevance: KT offers …
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Ivan Koay MBChB, MRCS, FRNZCUC, MD Applying the Ottawa Ankle Rule to Pediatric Patients Take-home point: Application of the Ottawa Ankle Rule (OAR) limits unnecessary imaging in children without missing clinically relevant fractures. Citation: de Almeida S, Rios J, Lima S, et al. Applying the Ottawa Ankle Rule in a pediatric emergency department. Pediatr Emerg Care. 2022;38(3):e1123-e1126. Relevance: Ankles fractures in children are common.Use of the OAR, a simple clinical decision rule, by UC providers …
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Urgent message: Approximately one quarter of pediatric ambulatory visits result in antibiotic prescriptions, with over one third of those exceeding guideline-recommended durations. Factors that influence urgent care providers toward longer durations have not been studied previously. Megan Hamner, MD; Amanda Nedved, MD; Holly Austin, MD; Donna Wyly, RN, MSN, CPNP-AC, PPCNP-BC; Alaina Burns, PharmD, BCPPS; Brian Lee, PhD, MPH; and Rana E. El Feghaly MD, MSCI Citation: Hamner M, Nedved A, Austin H, Wyly D, …
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Urgent message: After a brief hiatus during the peak of the COVID-19 pandemic, the rate of new sexually transmitted infections has resumed at epidemic rates in the United States. With many specialty STI clinics having closed, urgent care may be better positioned than ever to help curb their spread. Glenn Harnett, MD Citation: Harnett G. The rising importance of urgent care in the fight against the STI epidemic. J Urgent Care Med. 2022;16(3):15-20. Key words: …
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A 79-year-old male with past medical history of hypertension and coronary artery disease presents to urgent care with left shoulder pain that is worse with movement. He reports intermittent nausea and vomiting, but denies dizziness, chest pain, shortness of breath, or history of trauma. View the ECG taken 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 32-year-old immunocompetent male presents with fever, cough, arthralgia, and photophobia for a few days. On examination, he had a temperature of 100°F (37.8°C) and conjunctival injection. There was a widespread erythematous macular rash on his wrist. When asked about travel, the patient mentioned that he recently visited his family in the Dominican Republic. During his travels, he drank local water and sustained a few mosquito bites. His symptoms began approximately 4 days after his …
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