High-Risk Conditions Presenting as Back Pain (Part 2)
Urgent message: Significant cervical spine injuries are rare in urgent care but missing one can have serious implications for patient and provider. ERICA MARSHBURN, BS, BA, and JOHN SHUFELDT, MD, JD, MBA, FACEP In this continuing series on back pain diagnostics in urgent care medicine, we urge providers to carefully consider any high-risk spinal conditions that could be presenting as simple back pain. Although many cases of back pain can be attributed to musculoligamentous injury …
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April 2012
Spontaneous Pneumothorax
Urgent message: In patients with chest pain, check chest films carefully to avoid missing an uncommon diagnosis. Joseph Toscano, MD Introduction The traditional differential diagnosis for chest pain includes spontaneous pneumothorax. Chest x-ray is necessary for confirming the diagnosis, and sometimes the findings can be subtle. As in dealing with any infrequently encountered condition, clinicians should consider the diagnosis and closely examine every chest film they order to avoid missing this uncommon diagnosis. Case Presentation …
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December 2011
A Painful Swollen Joint in an Elderly Male
Urgent message: The patient had two recent bee stings. Did they cause his problem or were they red herrings? PAUL BURES, DO, and LEE A. RESNICK, MD Introduction Hot, swollen, tender joints are a common initial complaint in the urgent care setting. Depending on the patient’s HPI and PMH, a definitive diagnosis can often be concluded. A systematic evaluation of infectious, inflammatory, and traumatic causes can help narrow the differential. Judicious use of the laboratory …
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October 2011
A Surprising Cause for “Pregnancy”
Urgent message: When a test does not confirm a patient’s theory about the cause of her symptoms, both patient and provider must look elsewhere. SEAN MCNEELEY, MD Introduction When a mother of three complains of symptoms of pregnancy, the test usually confirms that she is right. Occasionally, however, the results are surprising, as this case illustrates. Case Presentation WM, a 28-year-old female, presented to an urgent care with concerns that she might be pregnant and …
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September 2011
A Surprising Cause for Constipation?
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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