Practice Management
A 38-year-old man present to urgent care complaining of pain around his entire pelvis after a fall on a slippery floor at home. Imaging is obtained. Review the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page.
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An 18-year-old male presents to urgent care with widespread abdominal “gas pain” for several days. He denies changes in diet or changes in bowel habits. However, he recalls having a hard collision with another player during a lacrosse game prior to onset of symptoms. 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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The patient is a 36-year-old male who presents with left hip pain for “years.” The pain is motion- or position-related and over time there has been occasional pain in his buttock, back, and thigh. Additionally, he has stiffness, clicking, locking, and catching. 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: Musculoskeletal pain is a common urgent care complaint, with x-rays very commonly ordered. However, a “normal” image does not necessarily support eliminating what could be a serious injury from the differential diagnosis. Arun Sayal, MD, CCFP(EM) Citation: Sayal A. When X-Rays Lie: Important Orthopedic Diagnoses to Consider with Normal Imaging. J Urgent Care Med. 2022;16(7):13-16. Medical tests lie. Not intentionally, of course, but their result may not align with reality. A test may …
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The patient is a 31-year-old male who presents with lateral ankle pain after an inversion injury during a game of basketball. 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: Nurse-initiated protocols (NIPs) have been found to be beneficial in emergency department settings. Nurse-initiated x-rays for ankle and foot injuries can reduce patients’ length of stay while improving staff satisfaction. Utilization of NIPs in an urgent care setting can bring positive benefits to patients, staff, and the organization. Allison Usset Gilles, DNP, FNP-C, RN; Der Xiong, DNP, FNP-C, RN; and Jenny A. Prochnow, DNP, MBA, RN INTRODUCTION Background Overcrowding and long wait times …
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The patient is a 35-year-old male who presents with chest pain, which he reports started after he was hit in the chest with an errant pass during his son’s basketball practice. View the image taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. Figure 1.
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The Food and Drug Administration has issued a new guidance suggesting there should be something of a kids’ menu for imaging, one that employs the lowest dose of radiation possible when imaging younger patients (or avoids x-rays altogether, if feasible). “Pediatric patients generally require less radiation than adults to obtain a quality image from an x-ray exam, so doctors must take extra care to ‘child size’ the radiation dose,” the FDA said in a statement. …
Read MoreQ. I understand that there will be reductions for x-ray reimbursements from Medicare in 2017. Is this true? A. To give imaging providers an additional incentive to adopt more advanced x-ray technology, Medicare will reduce reimbursement, beginning in 2017, for the technical component (and the technical component of the global fee) in claims submitted for x-rays performed with analog equipment. The cuts will continue in future years for those using computed radiography equipment (Table 1). …
Read MoreCase A 29-year-old woman presents to an urgent care center after a fall from the roof of her house, where she was cleaning the gutters. She reports that her right heel began hurting intensely immediately after the fall and that the pain worsened in the time it took for a family member to get her to the center. She cannot bear weight on her right leg. She mentions that she is a runner who often takes part in …
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