Primary Care: Clinics in Office Practice This is an RSS file. You can use it to subscribe to this data in your favourite RSS reader or to display this data on your own website or blog.

A Stitch in Time
Before repairing a laceration, consider the mechanism and severity of the injury. Gentle irrigation of the wound helps to remove microscopic infectious agents and larger debris. Not all foreign bodies are visible in plain radiographs. Certain wounds may be allowed to heal without operative intervention, but most patients prefer an approach using suture thread or tissue adhesive. Prophylaxis against tetanus, rabies, and/or bacterial infection should be considered. Clinical assessment of each wound is important to guide decisions about technique, anesthetic, suture material, and the interval period before nonabsorbable equip...
Source: Primary Care: Clinics in Office Practice - January 13, 2022 Category: Primary Care Authors: Benjamin Silverberg, Amy Moyers, Benjamin I. Wainblat, Peter Cashio, Kevin Bernstein Source Type: research

Point-of-Care Ultrasound for Musculoskeletal Injection and Clinical Evaluation
This article reviews POCUS basics and presents evidence and best practices for the use of POCUS for musculoskeletal-guided injection and clinical evaluation of the heart, lungs, abdominal aorta, lower extremity deep veins, soft tissue infection, and foreign bodies. (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - January 13, 2022 Category: Primary Care Authors: Jared Dubey, Brian Shian Source Type: research

Small Joint, Tendon, and Myofascial Injections
This article reviews injections for carpal tunnel, first dorsal compartment, trigger finger, ganglion cysts, trigger point, and plantar fascia. Necessary equipment should be gathered before the procedure and informed consent should be obtained. Indications, contraindications, and possible complications should be reviewed. Complete understanding of anatomy before injection is paramount. The injection technique should minimize risk of infection. There are no evidence-based postinjection protocols, and outcomes vary depending on the site and medication injected. (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - January 5, 2022 Category: Primary Care Authors: Lindsay Lafferty, Smriti Gupta, Ashley Koontz, Cayce Onks Source Type: research

Management of Chronic Wounds
Chronic wounds originate from venous hypertension, arterial insufficiency, or pressure-induced ischemia. Determination of the type and associated causes and contributory conditions is essential for the diagnosis and management of these common conditions. (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - January 5, 2022 Category: Primary Care Authors: Ashley Morrison, Charles Madden, John Messmer Source Type: research

Nail and Foot Procedures
This article discusses the removal of toenails, both full and partial removal. Subungual hematoma/Subungual blistering evacuation as well as wart, corn, callus, and blister management will also be discussed. (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - January 5, 2022 Category: Primary Care Authors: Justin Bailey Source Type: research

Skin Biopsy Techniques
Because many skin lesions and disorders can appear similar, primary care clinicians often struggle to diagnose them definitively without histopathologic information obtained from a biopsy. This review article explains how to decide whether a lesion should be biopsied and what type of biopsy technique to use and then outlines the stepwise approach to each of the most common skin biopsy techniques: shave, saucerization, punch, fusiform, and subcutaneous nodule biopsies. Finally, potential pitfalls and complications are discussed so the clinician can avoid those and can provide a cosmetically acceptable result from these comm...
Source: Primary Care: Clinics in Office Practice - January 4, 2022 Category: Primary Care Authors: Jason D. Greenwood, Stephen P. Merry, Christopher L. Boswell Source Type: research

Abscess Incision and Drainage
An abscess is a localized collection of purulent material surrounded by inflammation and granulation in response to an infectious source. Most simple abscesses can be diagnosed upon clinical examination and safely be managed in the ambulatory office with incision and drainage. Wound culture and antibiotics do not improve healing, but packing wounds larger than 5  cm may reduce recurrence and complications. (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - January 4, 2022 Category: Primary Care Authors: Jaime K. Bowman Source Type: research

Assorted Skin Procedures
Clinicians in the primary care setting will encounter various different skin conditions requiring procedural intervention. There are many different procedural approaches to treatment. Knowing which modalities are available and best suited to handle a particular skin lesion allows for flexibility for patient and clinician. Although some treatment modalities may be used more than others, it is helpful to be at least familiar with basic in office skin procedures such as removal of foreign bodies, cryotherapy, electrosurgery, and treatment of keloids, as these procedures are helpful in addressing the wide variety of the most c...
Source: Primary Care: Clinics in Office Practice - January 4, 2022 Category: Primary Care Authors: Roland Newman, Karl T. Clebak, Jason Croad, Kevin Wile, Erin Cathcart Source Type: research

Large and Intermediate Joint Injections
Olecranon bursitis, greater trochanteric bursitis, medial epicondylosis, and lateral epicondylosis are common diagnoses encountered in primary care and sports medicine clinics. This section explores the anatomy, clinical presentation, evaluation, procedural techniques, and management to effectively treat these common conditions. (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - January 4, 2022 Category: Primary Care Authors: Kimberly Kaiser, Michael Fitzgerald, Brady Fleshman, Kathleen Roberts Source Type: research

Managing Fractures and Sprains
Primary care physicians are often the first to evaluate patients with extremity injuries. Identification of fractures and sprains and their proper management is paramount. After appropriate imaging is obtained, immobilization and determination of definitive management, either nonoperative or operative, is critical. Appropriate immobilization is imperative to injury healing. Nonsurgical management of upper extremity fractures often uses slings, short-term splinting, gutter splints, and/or short or long arm casts. Initial fracture stabilization of the lower extremity is usually accomplished with a posterior splint. Definitiv...
Source: Primary Care: Clinics in Office Practice - January 4, 2022 Category: Primary Care Authors: Nathan Falk, Bernadette Pendergraph, T. Jason Meredith, George Le, Hannah Hornsby Source Type: research

Procedures in Primary Care: Meeting the Comprehensive Needs of Our Patients Where They Are
Primary care remains at the front lines in the delivery of patient care. In many of our communities across the United States, patients have limited access to specialty care. Population growth, the aging of the American population, in addition to increased access to care with the Affordable Care Act, have combined to drive the demand for procedural care and highlight the effects of physician shortages.1 Primary care clinicians have risen to meet this unmet need by continuing to deliver comprehensive care within our communities. (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - January 4, 2022 Category: Primary Care Authors: Karl T. Clebak, Alexis Reedy-Cooper Tags: Preface Source Type: research

You ’re a Dermatologist Too?
Since I completed my residency training in 1999, I have enjoyed a challenging and rewarding career in academic family medicine. While my original plan was to go to medical school and become a surgeon, like many medical students in their clerkship year I found myself liking essentially everything and struggling to commit to a single subspecialty for fear that I would be narrowing my focus in patient care. I realized during my residency that family medicine gave me the opportunity to develop a broad expertise in all areas of medicine and to become skilled in many procedures. (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - January 4, 2022 Category: Primary Care Authors: Joel J. Heidelbaugh Tags: Foreword Source Type: research

Dermoscopy in Primary Care
Dermoscopy is a noninvasive technique that allows in  vivo magnification of the skin structures and helps in visualizing microscopic features that are imperceptible to the naked eye. Dermoscopy is not a substitute for biopsy and histopathologic evaluation, but is an important tool that can help increase diagnostic sensitivity and specificity of cutan eous lesions. Dermoscopy increases the diagnostic sensitivity compared with naked eye examination. A significant improvement in diagnostic accuracy for benign and malignant lesions has been reported among family medicine physicians after an introductory training course on der...
Source: Primary Care: Clinics in Office Practice - January 3, 2022 Category: Primary Care Authors: Prabhat K. Pokhrel, Matthew F. Helm, Amrit Greene, Leesha A. Helm, Michael Partin Source Type: research

Think of Yourself as a Comprehensivist
What exactly is it that makes office-based procedures so much fun? There ’s got to be something, because as residency faculty, procedures training is one of the most common aspects of our program that applicants ask about. Residency applicants don’t yet realize that procedures notes are quicker to write than typical clinic notes. They have not done enough procedures to appreciate the satisfaction that comes from performing an entire vasectomy through a tiny tear in the scrotum, or from reducing a Nursemaid elbow using just your hands. (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - October 29, 2021 Category: Primary Care Authors: J. Lane Wilson, Jonathon Firnhaber Tags: Preface Source Type: research

“Oh, You Can Do That?”
I went to medical school to be a surgeon. At least, that ’s what I thought I wanted to become because I loved the prospect of doing procedures. I had no real knowledge of primary care, what it encompassed, and what a career in primary care could provide for my patients. Just last week one of my students said to me, “I thought all you did in primary ca re was physicals and refer patients to specialists.” Yes, we’ve all heard this inaccurate stigma before, and we’ve all tried to successfully break it down. (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - October 29, 2021 Category: Primary Care Authors: Joel J. Heidelbaugh Tags: Foreword Source Type: research