Practice Management
Urgent message: Swelling of the neck is a common problem seen in the urgent care setting. Etiologies range from infectious to lymphatic to malignant. If serious conditions are not diagnosed and treated in a timely manner, complications may lead to airway compromise, sepsis, or even death. How this article helps you: alerts you to uncommon presentations of neck masses. Introdution Swelling in various areas of the neck is frequently seen in urgent care centers. Most …
URGENT MESSAGE: America’s undocumented immigrant population—those who are ineligible for Medicaid, Medicare, or private insurance via a state or federal exchange—are increasingly served by storefront “bodega clinics” that offer a range of services on a walk-in, cash-pay basis. While these “clinicas” provide much-needed access to the communities they serve, there are also concerns about the quality and oversight of their operations. Nonetheless, they could also teach many urgent care centers a thing or two about …
A 37-year-old woman without a significant past medical history presents after 3 days of a cough that produces yellow sputum with some streaks of blood. She has not checked her temperature but says she has “felt warm” and has some chills. She does have associated shortness of breath, but she reports that she has not had chest pain, leg pain or swelling, sweating, or headache. She has a history of hypertension, and she takes an …
SEAN M. McNEELEY, MD Dexamethasone May Be Worthwhile in Treating Adult Asthma Key point: Dexamethasone is almost as good as prednisone in treating asthma in adults. Citation: Rehrer MW, Liu B, Rodriguez M, et al. A randomized controlled noninferiority trial of single dose of oral dexa- methasone versus 5 days of oral prednisone in acute adult asthma. Ann Emerg Med. 2016 April 22. doi: 10.1016/ j.annemergmed.2016.03.017. [Epub ahead of print.] In a randomized placebo-controlled trial …
SEAN M. McNEELEY, MD Results Unavailable for 71% of Trials Key point: Many research findings are not easily available to clinicians. Citation: Chen Ruijun, Desai NR, Ross JS, et al. Publication and reporting of clinical trial results: cross sectional analyis across academic medical centers BMJ. 2016;352:i637. Researchers investigated the amount of clinical trial findings at academic medical centers that are not published and thus not easily available to clinicians. In a cross-sectional analysis of academic …
It’s well known that the retail industry has a nasty habit of overreliance on the holiday season to buffer slower sales throughout the year. When the economy is strong, retail sales typically follow, and investors are happy. When the economy falters or when brick-and-mortar retail is disrupted by lowercost, more-convenient alternatives, investors feel a bit under the weather. Similarly, the urgent care dilemma has always been a relative dependence on flu season to account for …
SEAN M. McNEELEY, MD Copeptin and Troponin Together Are Useful in Diagnosing Acute Coronary Syndromes Key point: There is a new tool for ruling out myocardial infarction. Citation: Ricci F, Di Scala R, Massacesi C, et al. Ultra-sensitive copeptin and cardiac troponin in diagnosing non-ST-segment elevation acute coronary syndromes—the COPACS Study. Am J Med. 2016;129:105–114. Concern about patients with non-ST-segment elevation myocardial infarction with chest pain and normal electrocardiogram (ECG) findings frequently causes a transfer …
A 37-year-old man presents to an urgent care center after 2 days of fever and sore throat. He reports that the soreness is worse with swallowing. He reports that he did not have any preceding rhinorrhea or myalgias. He has had no exposure to ill persons, and he has no history of previous illnesses. He reports that he smokes cigarettes and occasionally drinks alcohol. View the image taken (Figure 1) and consider what your diagnosis …
The Centers for Disease Control and Prevention’s warnings that the 2015–2016 might end up being late, and not just light, are coming to fruition from coast to coast—with deadly consequences for some. New data highlight the need for urgent care providers to continue pushing flu shots and to be prepared for more patients with flu-like symptoms. Current flu activity has been called “widespread” in 37 states, with physician visits for flu-like symptoms continuing to rise; …
Q. How do I use Excludes 1 and Excludes 2 instructions in International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10CM)? A. Put simply, the Excludes 1 notation means that you cannot code any excluded code with the main (listed) code. Conditions listed with Excludes 1 are mutually exclusive. For example, code E11 (type 2 diabetes mellitus) has an Excludes 1 notation with the following codes listed: Diabetes mellitus due to underlying condition (E08.-) Drug …