Ashley Blachford, Author at Journal of Urgent Care Medicine

Meet the New Urgent Care Boss—Not the Same as the Old Boss

Back in the day, you probably would have been right to assume that the closest urgent care center was founded, owned, and run by a physician. Many other practices (primary care, pediatric…) would have been the same. Well, times have changed in a big way. The mavericks who simply wanted to find a better, more sensible way of practicing medicine and wound up creating a new industry are now employees of national and regional health …

Similar to Past Flare Ups Pulmonary Eosinophilia: Putting the Pieces Together

Urgent message: Pulmonary eosinophilia is a generic term for a heterogeneous group of disorders that result in increased eosinophils within the pulmonary parenchyma. Ultimately, the patient here was treated with an extended course of glucocorticoids to treat his chronic eosinophilic pneumonia until he could follow up with his hematologist/pulmonologist. CASE PRESENTATION The patient is a 29-year-old male with history of pulmonary eosinophilia, degenerative disc disease, and asthma who presents to an urgent care center with …

Best Practices for LGBTQ-Friendly Urgent Care

Urgent message: LGBTQ individuals are subject to implicit and explicit bias in our society, ranging from microaggressions and antagonistic legislation to overt discrimination and harassment. This can inhibit willingness to seek medical care—and, subsequently, lead to worse health outcomes. Given the more accessible, episodic nature of urgent care, understanding how word choice and other subtle cues communicate our competency in working with LGBTQ patients can help us engender trust more quickly. INTRODUCTION The goals for …

A 71-Year-Old with Diabetes and Discoloration of the Skin

The patient is a 71-year-old female with type 2 diabetes who calls attention to a rash on her shins during an annual physical. The rash appears to be pink, atrophic scars surrounded by hyperpigmented patches. They have developed since her last physical. She denies discomfort but is concerned as to what could have caused them. View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described …

A 31-Year-Old with Cough and Decreased Breath Sounds

The patient is a 31-year-old woman who presents with new-onset cough and decreased breath sounds to the lower lobes. View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

Approach to Syncope in Children and Adolescents

Urgent message: Syncope in pediatric patients may be attributed to a wide variety of sources. As such, it is essential to keep a broad differential and to eliminate potentially life-threatening etiologies. Nehal Bhandari, MD, FAAP and Abbas Zaidi, MD, FAAP CASE PRESENTATION A 12-year-old previously healthy female presents to urgent care with several episodes of “blacking out” over the past 4 days. Each episode has occurred when she stands up from a sitting or supine …

Abstracts in Urgent Care – September 2021

Cooling Pain from Digital Nerve Blocks Safety of Corticosteroids in Children Predicting the Course of Pediatric CAP Is Tranexamic Acid Helpful for Epistaxis? Drug Therapy for Sciatica Imaging May Not Correlate with Lumbar Pain COVID-19 Vaccination in Lactating Patients Applying Ice Reduces Pain from Digital Nerve Blocks Take-home point: Use of an ice pack applied prior to the administration of a digital nerve block reduces pain from local anesthetic injection Citation: Rasooli F, Sotoodehnia M, …

A 57-Year-Old Female with Cardiological History and Shortness of Breath

The patient is a 57-year-old female with a history of coronary artery disease, congestive heart failure, and left ventricular thrombus on warfarin who presents with shortness of breath. She denies any bleeding, bruising, dark-colored stools, chest pain, fever, cough, or leg pain. On evaluation, the patient’s vital signs are normal. She is breathing comfortably and speaking in complete sentences. View the ECG and consider what your next steps and diagnosis would be. Resolution of the …

Discrepancy Rates in Radiograph Interpretations between Pediatric Urgent Care Providers and Radiologists

Urgent message: Many pediatric urgent care centers lack 24/7 pediatric radiologist coverage and rely on the urgent care provider for initial interpretation and subsequent clinical management. If misdiagnosed, this could represent a potential patient safety concern. Allison Wood, DO; Anne McEvoy, MD; Paul Mullan, MD, MPH; Lauren Paluch, MPA, PA-C; Brynn Sheehan, PhD; Jiangtao Luo, PhD; Turaj Vazifedan, DHSc; Theresa Guins, MD; Jeffrey Bobrowitz, MD; and Joel Clingenpeel, MD Citation: Wood A, McEvoy A, Mullan …

What the #$%^ is happening with EM Coding and Reimbursement?! – Part II

In the May issue of JUCM, we outlined what we were seeing with E/M coding levels utilizing the new AMA guidelines vs 2020 and 2019 levels. As COVID-19 visits steadily declined from January through June, we began to see a return to more “normal” urgent care visits. That was short-lived. July’s sharp increase in visit volumes was again driven by COVID-19! Here’s the update we promised. As a reminder, we saw E/M levels decline in …