Practice Management
Urgent message: Do not be fooled by the diagnosis made by clinicians before you. Many seemingly benign symptoms can be harbingers of more serious pathology. JESSICA HOFFMANN, MS-4, and JOHN SHUFELDT, MD, JD, MBA, FACEP Chronic back pain is a common presentation in both the urgent care and emergency department (ED) settings. Care-on-demand providers often find themselves deciding how extensive a workup to do for a patient with acute-on-chronic back pain. After a patient has …
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Urgent message: Be on the lookout for periostitis in patients with syphilis who present with extremity pain. MAY MOHTY, MD, FAAP, FAAUCM, and CASEY PHILIPSBORN, MSIV Syphilis (from the Greek word Syphlos, meaning crippled) is an infectious disease caused by the spirochete species Treponema pallidum. Patients can present with manifestations of any of the three stages of syphilis, ranging from a painless ulcer to an asymptomatic rash, to general paresis and dementia, among a myriad …
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Urgent message: Urgent care clinicians should consider the possibility of cholecystitis when evaluating patients with cardiac symptoms. A delay in diagnosis may lead to serious complications, including sepsis. ALONA D. ANGOSTA, PhD, APRN, NP-C, and BRYAN HOLMES, NREMTP Introduction Patients with acute cholecystitis typically complain of right-upper-quadrant pain that radiates to the right shoulder and back, fever, and leukocytosis.1 The pain may also be associated with nausea or vomiting. However, acute cholecystitis can mimic cardiac …
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Urgent message: As the number of patients with autism spectrum disorders continues to increase, it is important that urgent care providers proactively educate themselves about how best to provide acute care for these individuals. ELIZABETH MANGONE and JOHN SHUFELDT, MD, JD, MBA, FACEP A 14-year-old autistic male presents with both parents. The patient is non-verbal and hypersensitive to touch. The parents state that he was stung by a bee and seems to be having respiratory …
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Urgent message: Chest pain in young adults is often benign but it’s important to always consider conditions that increase risk of cardiovascular disease when evaluating these patients. RAFAEL ILYAYEV, MD, FACP, MOHAMED A. MOHAMED, MD, AND HASSAN FARHAT, MD Overview This case illustrates the importance of considering and ruling out rare causes of coronary artery disease (CAD) in young patients who present with chest pain. One of these rare causes is a hypercoagulable state secondary …
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Urgent message: Visceral injury is possible in association with the seemingly minor trauma seen in urgent care, underscoring the importance of remaining alert for “red flag” signs and symptoms and judiciously using advanced diagnostics. Introduction Blunt abdominal trauma occurs in 10% to 15% of injured children.1 History and specifically mechanism of injury, and physical exam are important when a patient presents to the clinic with a suspected blunt abdominal trauma. Usually, injuries to the intra-abdominal …
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