Practice Management
The patient is a 26-year-old man who presents after 3 days of palpitations. He denies any chest pain, shortness of breath, diaphoresis, fever, or dizziness. He does use home oxygen (2 L/min), but denies any new shortness of breath. Upon exam, you find: General: Alert and oriented X 3 Lungs: Clear to auscultation bilaterally Cardiovascular: Regular and tachycardic without murmur, rub, or gallop Abdomen: Soft and nontender without rigidity, rebound, or guarding Extremities: No pain …
Read More
The patient is a 9-year-old boy who was brought in by his parents with right knee pain. He reports that he twisted it while reenacting Star Wars battles in the backyard with friends. His parents did not witness the injury. View the image taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
Read More
Urgent message: Back pain is a common complaint in the urgent care setting. Common causes of musculoskeletal back pain include overuse and work-related injury. Other causes can include disc herniation, metastasis, osteoporosis, arthritis, spinal stenosis, and nephrolithiasis. Crystal N. Bharat MD, Ronald Dvorkin, MD, and Glenn G. Gray MD Case Presentation A 65-year-old female complained of 1 day of low back pain radiating to her left flank, which was aggravated with movement. Symptoms began while …
Read MoreBrain Study Suggests a Link Between CTE and Football—Even Among Youths Key point: A high proportion of deceased players of American football showed pathological evidence of chronic traumatic encephalopathy, suggesting that CTE may be related to prior participation in football. Citation: Mez J, Daneshvar DH, Kiernan PT, et al. Clinicopathological evaluation of chronic traumatic encephalopathy in players of American football. JAMA. 2017;318(4):360–370. This widely referenced JAMA study presents a convenience sample of 202 deceased players of …
Read MoreConnecticut Democrats Seek Regulations for Urgent Care Centers. When this alert hit my inbox, I must say it was a bit alarming. Whenever I see “urgent care” and “regulations” in the news it’s unsettling to say the least. I am probably not alone. The regulatory rumblings have come and gone before, but this one has me more concerned. Here’s a little background: Connecticut legislators and the state Department of Public Health (CDPH) have been interested …
Read MoreValidating a Quantitative EEG-Based Brain Function Index Key point: A novel EEG-based point of care, handheld, and noninvasive head injury assessment device, utilizing an index based on EEG measures reflective of concussion, was demonstrated to provide a quantitative index of brain function impairment in mild traumatic brain injury (mTBI). Citation: Hanley D, Prichep LS, Badjatia N, et al. A brain electrical activity (EEG) based biomarker of functional impairment in traumatic head injury: a multisite validation …
Read More
Urgent message: Acute aortic obstruction should be suspected in all patients with back pain and a history of peripheral vascular disease and atrial fibrillation, as over 50% of these cases are misdiagnosed, resulting in high mortality rates in affected patients. Kristopher Palmer, DO and JM Alderson, DO Introduction Aortic occlusion is a rare but potentially fatal vascular phenomenon that must be considered in all patients with peripheral vascular disease (PVD) complaining of severe pain. Here, …
Read More
A 40-year-old woman visits your urgent care center several days after first noticing a rash of pruritic smooth papules on her trunk and intertriginous areas. She reports that she had been spending a lot of time in the pool with her children before they returned to school. Now she also has a fever and swollen glands, and complains of general malaise. View the photo and consider what your diagnosis and next steps would be. Resolution …
Read More
A 42-year-old woman with a history of anxiety presents, complaining of intermittent palpitations over the past 2 weeks. She says she has not taken any medication and denies chest pain, shortness of breath, diaphoresis, fever, or dizziness. Upon exam, you find: General: Alert and oriented X 3 Lungs: Clear to auscultation bilaterally Cardiovascular: Regular and tachycardic without murmur, rub, or gallop Abdomen: Soft and nontender without rigidity, rebound, or guarding Extremities: No pain or swelling, …
Read MoreThe patient is a 25-year-old male who presents with pain over the distal phalanx of the middle finger. He says he hit it with a hammer while hanging a picture frame in his new apartment a short while ago. Pain is evident upon palpation over the distal phalanx of the middle finger, but there are no cuts or breaks in the skin. Neurovascular status is intact. View the image taken (Figure 1) and consider what …
Read More