Practice Management
The patient is a 30-year-old male who presents with 2 days of difficulty swallowing and what he calls a painful “bump” on the right side of his neck. View the images taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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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 patient is a 17-year-old female who presents with neck pain a day after attending a rock concert. She denies cigarette smoking, vaping, use of illicit substances, or physical trauma. View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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Urgent message: Though neck pain is a common complaint among patients presenting to urgent care centers, cervical facetitis is a relatively uncommon cause. Nonetheless, urgent care providers should consider it in the differential diagnosis for patients presenting with neck pain, even those who are afebrile. Mark Richman, MD, MPH; Brendan Appold, MS; and Jennie Soniega-Sherwood, MPH Case Presentation The patient is a 62-year-old-female with no significant past medical history who presented to a hospital-based urgent …
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Urgent message: Clinicians must be able to determine the cause and severity of injury in patients with neck pain, especially in the very young, whose symptoms vary according to their developmental status, and in the elderly, who have weaker bones and degenerative changes. Introduction Avariety of patients from children to the elderly will present to an urgent care Center with the chief symptom of neck pain. Cervical spine (C-spine) injuries occur in 3.7% of adults …
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A 38-year-old man presents to an urgent care center and reports pain in his right heel and ankle that he describes as severe enough that he cannot walk on the foot. He says that the pain began the previous evening when he landed on the group after jumping out of a second-floor window on a dare. He has some minimal paresthesia, but he has no fever, vomiting, head trauma, head or neck pain, or chest …
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Urgent message: The differential diagnosis of neck pain is broad. A systematic and effective approach is required to rule out life-threatening conditions. RANIER NG, DO, and MICHAEL ROWANE, DO, MS, FAAFP, FAAO Neck pain is a frequently encountered complaint in urgent care. About two-thirds of the population will experience neck pain at some point in their lives.1 Many patients experience a sense of debilitation with every movement of their neck. Patients may perceive neck pain …
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Urgent message: Injuries sustained in playground falls are common presentations to emergency departments and urgent care centers alike. The urgent care physician should be alert to the keys to evaluation and management of traumatic neck pain. Muhammad Waseem, MD, Lalithambal Venugopalan, MD, and Gerard Devas, MD Cervical spine (C-spine) injuries occur infrequently in children. This is especially true for fractures of atlas vertebra, which is a rare injury in children. Its diagnosis may easily be …
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This article is the second in a series that will sequentially answer the following questions: What is the incidence of bouncebacks? What is the incidence of bounceback admissions? What is the incidence of deaths in patients recently discharged from the ED? What percent of bouncebacks occur because of medical errors? How can we use this information to improve patient safety? In the September issue of JUCM, we discussed several studies which found the incidence of …
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