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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Urgent Message: Acute coronary syndromes (ACS), including ST-elevation myocardial infarction (STEMI), may present with predominant back pain or other non-chest-pain symptoms. Additionally, electrocardiogram findings in cases of coronary occlusion may not always meet STEMI criteria. It is important to include myocardial ischemia and ACS in the differential for back pain presentations, especially when the pain is not reproducible. Sarah Mannon OMS-3; Lauren Schuermann OMS-3; Michael B. Weinstock, MD Citation: Mannon S, Schuermann L, Weinstock M. …
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Click Here to download the PDF Urgent message: By the time an adverse outcome occurs in the urgent care center, it’s too late to go back and ensure the documentation reflects the care the patient received. Lyndsie Pfeifer, DO; Marta Fratczak, Kinkela Harkins, and Michael Weinstock, MD Citation: Pfeifer L, Fratczak M, Harkins K, Weinstock M. Back pain, an urgent care visit—and a devastating outcome. J Urgent Care Med. 2023;17(8):13-17. Key words: back pain, documentation …
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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: Failure to consider subtleties and the context in which a patient presents can lead to insufficient differential diagnoses and, therefore, mis- or missed diagnoses that leave the patient at risk for poor outcomes and the provider at risk for litigation. Michael Weinstock, MD and Charles Pilcher, MD Back pain is usually back pain, whether it’s from a muscular strain or another self-limiting, non-serious cause. But there is potential danger lurking below the surface, …
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The Importance (or Not) of High BP Readings Learning While Driving—Does It Work? Considering Sucralfate in Pediatric Oral Ulcers Osteopathic Manipulation for Low Back Pain Safety of Oral Corticosteroid Bursts in Children Nathan M Finnerty, MD FACEP and Brett C Ebeling, MD Do High Blood Pressure Readings Matter? Take-home Point: Elevated blood pressure readings in the emergency room were not associated with an increased risk of poor cardiovascular outcomes in 2 years. Citation: McAlister F, …
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Cooling Pain from Digital Nerve Blocks Safety of Corticosteroids in Children Predicting the Course of Pediatric CAP Is Tranexamic Acid Helpful for Epistaxis? Drug Therapy for Sciatica Imaging May Not Correlate with Lumbar Pain COVID-19 Vaccination in Lactating Patients Applying Ice Reduces Pain from Digital Nerve Blocks Take-home point: Use of an ice pack applied prior to the administration of a digital nerve block reduces pain from local anesthetic injection Citation: Rasooli F, Sotoodehnia M, …
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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 …
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A 21-year-old male presents to your urgent care center complaining of back pain after falling from a ladder. He is unclear about the exact point of impact, but the pain increases with attempts to bend or twist. Examination reveals he has decreased range of motion. View the image taken (Figure 1) and consider your next steps, along with possible diagnoses.
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There’s no shortage of patients reporting to urgent care centers with back pain being their chief complaint. A new study published in Annals of the Rheumatic Diseases confirms they’re not likely to get satisfactory relief from nonsteroidal anti-inflammatory drugs (NSAIDs), though. Machado, et al looked at 35 randomized, placebo-controlled trials that compared the efficacy and safety of NSAIDs with placebo for spinal pain. They found that treatment effects met the threshold for clinical importance in …
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