One of the most common chief complaints in primary care, urgent care, and emergency room settings is that of low back pain. It is, in fact, according to a presentation by Roger Chou, MD, per Providers Clinical Support System, the 5th most common reason for office visits in the United States. That equates to about 5% of primary care office visits. The prevalence of this chief complaint is rising, which is resulting in more prescriptions of opioids for treatment of this pain. Opioids are, in fact, the most commonly prescribed medication for low back pain. However, given that we are in the midst of an opioid crisis, the last thing we, as providers, want to do is to contribute to this problem, if at all possible. So, what exactly can we do to treat our patients effectively, while minimizing harm to the patient, and potentially to others?
Have you ever had your tooth knocked out?
If you answered yes, you are not alone and probably know what to do. But if you have not, you will be someone’s hero in knowing how to manage a knocked out tooth.
People often present to an emergency room, or urgent care setting with a foreign body lodged in an orifice. When the patient presents they will have a sense of urgency, and feel that it needs to “come out now”. This may or may not be the case. In order of most to least common, non-traumatic foreign bodies can become lodged in the throat, ears, nose, vagina, rectum and urethra. Patients may be adult or pediatric. Kids will often stick beads or buttons in their ears or nose, and will swallow just about anything. Adults may have an insect in their ear, esophageal food impaction, or engage in foreign body insertions during sexual practices. In this blog we will talk about HEENT/Esophageal foreign bodies.
Rachel Beatty, ARNP
Let’s discuss a common scenario. You have a 50 year old male who has not been seen by a PCP in two years. His past medical history includes arthritis and hypertension. He does not smoke and has an occasional beer on the weekend. He has been off his medications for his hypertension for over a year. His BP in office is 182/110, HR 70, Temp 97.6, Respirations 16, 02 saturation 98%. His physical exam is unremarkable and he is asymptomatic. Your medical assistant asks you if you would like her to give him clonidine and do an EKG. She then asks if we will be sending him to the emergency room. The patient is now anxious and is wondering if he is going to have a stroke. What would you do?