Practice Management
The patient is a 45-year-old male who presents with palpitations for the past 30 minutes. He denies chest pain, dizziness, or syncope. His vital signs are normal aside from tachycardia and he appears to be in no acute distress. View the ECG taken and consider what your diagnosis and next steps might be. Resolution of the case is described on the next page.
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A 43-year-old man presents to urgent care with a rash that he noticed a couple of days ago on his trunk. On exam, there is skin atrophy and multiple smooth papules and hypopigmented oval macules. Upon palpation of the lesions, you find that the examining finger “sinks” into a pit with distinct edges, like the ring of a hernia. The patient is immunocompetent, and his medical history is unremarkable except for lichen planus. He patient …
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The patient is a 16-year-old male who presents to urgent care with pain in the humerus area hours after finishing a baseball game. View the x-ray 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: Demand for DOT-related services for truck drivers is soaring. Urgent care centers can augment traditional insurance-paid visits with B2B relationships while serving a historically unhealthy population. Alan A. Ayers is President of Experity Consulting and Senior Editor of The Journal of Urgent Care Medicine. The commercial trucking industry in the United States is massive (Table 1). The U.S. Department of Transportation (DOT) requires that all commercial motor vehicle drivers receive a physical every …
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Michael Weinstock, MD; Gabby Gostigian, MD; and Matthew Delaney, MD Urgent message: Failure to consider subtleties and the context in which a patient presents can lead to insufficient differential diagnoses and missed diagnoses that leave the patient at risk for poor outcomes and the provider at risk for litigation. INTRODUCTION Cellulitis from a wound infection in the urgent care is common, and so is our management: wound care and antibiotics. But consider a scenario in …
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Joshua Russell, MD, MSc, FCUCM, FACEP Recently, a PA I supervise called me about a young woman who came in for hematemesis and melena at home. The provider, let’s call him Tom, told me that the patient had normal vital signs, but he thought she should still go to the ED. I could sense some reluctance in his voice though. It was probably because the patient was just 32 years old and looked well. Understandably, …
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Reducing the need for patients to visit hospital emergency rooms (as well as the associated cost) is an essential attribute and key selling point of the urgent care industry. Remarkably few studies have been conducted to confirm this in practice, however. When they are undertaken, they tend to prove that this isn’t just hype; proper utilization of urgent care really can preclude the need for many patients to go to the ED, and that really …
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Urgent message: Neck and back pain are common issues preceding surgical intervention. Given differences in care plans, outcomes, cost, and length of stay associated with spinal surgeries, the option of referring urgent care patients to either neurosurgeons or orthopedic spine surgeons requires careful consideration. Rami Musleh, PA-C; Angela Blagojevski, MPAS, PA-C; Randy Brush, MS, PA-C; and Jessica Bruskoski, MS, PA-C INTRODUCTION Neck and back pain are two of the most common reasons for people to …
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Urgent message: Throughout the COVID-19 pandemic, unvaccinated people have shown higher rates of morbidity and mortality in comparison with those who are fully immunized. While most vaccination adverse reactions are mild and self-resolving, it is important to consider the timeline of vaccinations to correlate possible adverse reactions. Amanda dos Santos, MD and Michael Pallaci, DO, FACEP, FACOEP INTRODUCTION The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic continues to affect all aspects of our society and …
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Ivan Koay MBChB, FRNZCUC, MD Achilles Tendon Rupture Predictive Value of Seamen’s Sign PT and Meniscus Tears Managing ACS in Rural Areas Following Up on Radiology Recommendations Syncope and Motor Vehicle Accidents Surgical vs Nonoperative Management of Achilles Tendon Rupture Take-home point: Surgery at 12 months postinjury was not associated with better outcomes compared with nonoperative treatment of Achilles tendon rupture. Citation: Myhrvold S, Brouwer E, Andersen T, et. al. Nonoperative or surgical treatment of …
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