Practice Management
Urgent message: Prescribing Miralax and an enema would likely have killed this patient. He nearly died in the hospital. Can you figure out why? WILLIAM A. GLUCKMAN, DO, MBA, FACEP, CPE, CPC Constipation, a common urgent care complaint, can be a symptom of many things, not all of them obvious, and some life-threatening. In this tricky case, the underlying problem is one that many urgent care physicians would not consider in a differential diagnosis, yet …
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Urgent message: Although pancreatitis is a common cause of abdominal pain, many of its signs and symptoms are shared by other intraabdominal conditions. Most patients can be handled on an outpatient basis if diagnosis is accurate, as this case illustrates. MICHAEL TALKAR, MD Abdominal pain is a common and varied presentation in urgent care. A history and physical exam can be used to triage the majority of emergent cases. Strong communication is vital to ensuring …
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Urgent message: Evaluation of chest pain in the low-risk patient can be daunting. This case, in which the patient had no known history of cardiovascular disease, exemplifies the challenge. MARREN J. WEBER, DO The standard treadmill exercise tolerance test (ETT) and echocardiography are widely used as the initial tests of choice for prediction of cardiovascular disease. Historically stress echocardiography has been recognized to perform well in predicting mortality in conjunction with clinical data and other …
Read MoreUrgent message: Although free air in the mediastinum is generally a benign, self-limited condition, most patients should be admitted to the hospital and observed for signs of serious complications, which could be fatal. By Tracey Quail Davidoff, MD A previously healthy 17-year-old male presents to urgent care with a one-week complaint of sore throat, fever, and nasal congestion. On the last day, he had experienced sharp chest pain, which worsened with deep inspiration, swallowing, and …
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Urgent message: There is no diagnosis so “common” that it cannot be missed or mistaken for something else. A systematic approach to the history and examination are crucial to reaching the right conclusion and positive outcomes. Lee A. Resnick, MD Every now and then, medical school pearls are wrong. You remember: “When hearing hoof beats in Central Park, don’t go looking for zebras.” It may be true that zebras are infrequent visitors to New York …
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Urgent message: Patient discomfort, inconvenience, and concerns—warranted or not—over possible vision loss make it essential for the urgent care clinician to quickly distinguish between benign conditions and those requiring referral, and to be able communicate clearly with the patient. By Eric Langerman, medical student, Colleen Czerniak, pharmacy student, Mikayla Spangler PharmD, Shailendra Saxena, MD, PhDAny ocular pathology can be distressing to the patient, as such conditions can often disrupt activity and even provoke concern about …
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Urgent message: Mechanism of injury – in case being thrown from a slow-moving vehicle – provides essential clues to the extent of injuries, even if the patient initially thought them to be relatively minor. Proper evaluation requires a thorough history. Shannon Dowler, MD The Case The patient is a 23-year-old female who presented to urgent care with an approximately 36-hour history of “shoulder pain.” She is otherwise well-appearing. Discussion with the patient reveals that she …
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Urgent message: Abdominal pain can be a challenging complaint, especially in younger patients. Consider the full range of differential diagnosis in order to initiate prompt, effective management. Curtis Kommer MD, Latha Shankar, MD, MBA and Robert Stuart, MD Introduction Since the time of Hippocrates, the ability of physicians to unravel the mystery of a patient’s abdominal pain has become synonymous with the art and practice of medicine. Pediatric abdominal pain, in particular, with its extensive …
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