Practice Management
Joshua Russell, MD, MSc, FCUCM, FACEP I didn’t want to send her to the ER, but what else could I do? Mrs. C was a gaunt 72-year-old Chinese-American woman who had never been to our clinic before. Her son carried her in at 7:56 pm like a bride across the threshold. “She cannot walk,” he said, startling the MA sitting at the front desk. “Has she been seen here before?” our MA asked …
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Urgent message: Medical histories can help inform diagnosis, but clinicians must ensure their decisions are not swayed by erroneous historical elements or cognitive biases. Candace Walkley, MD and Kyle Swanson, OMS-3 INTRODUCTION Staphylococcus aureus and Streptococcus pyogenes may cause acute and inflammatory infections of the soft tissue in immunocompetent patients. However, patients with indolent and progressive lymphocutaneous infections should be evaluated for atypical bacterial and fungal pathogens. CASE PRESENTATION In March 2021, a 57-year-old healthy …
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Bradley L. Laymon, PA-C, CPC, CEMC PRESENTATION A 47-year-old established male patient presented after 2 days of COVID-like symptoms (fever >100.5°F, cough, headache). Symptoms were mild and constant. He denied chest pain, shortness of breath, abdominal pain, rash, dizziness, and nausea/vomiting/diarrhea. He reported trying to alleviate the symptoms with acetaminophen and guaifenesin, with minimal relief. He has no known allergies The patient, who had never tested positive for COVID-19, acknowledged recent exposure to a colleague …
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The patient is a 16-year-old female with right-side neck pain after inadvertently swallowing a chicken wing. She has not eaten and has imbibed minimal fluids for more than 24 hours. 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: Metacarpophalangeal dislocations involving digits other than the thumb or index finger may be somewhat atypical, but are known to occur as a result of a fall on an outstretched hand—a common precedent to an urgent care visit. Familiarity with management of such injuries precludes the need to refer the patient. Leonard A. Powell, DO, MS, FACOFP, CMD and Chad E. Richmond, DO ABSTRACT Metacarpophalangeal (MCP) joint dislocations typically occur in a dorsal fashion …
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Joshua Russell, MD, MSc, FCUCM, FACEP I’m just going say it: we should repeat vital signs more often in urgent care. But from the odd looks I get whenever I work with a new medical assistant, I realize that asking for vitals to be rechecked isn’t common practice among my colleagues; it may even be frankly contrarian. So, before I lose you, I’ll concede that one set of vital signs is more than enough for …
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An 83-year-old female with past medical history of congestive heart failure and atrial fibrillation presents to urgent care with confusion and syncope. She reports intermittent dizziness, but denies chest pain or shortness of breath. There is no evidence of trauma on exam. View the ECG taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. (Case presented by Jonathan Giordano, DO, MEd, McGovern …
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A mother brings her 9-year-old girl daughter to your urgent care center because she’s concerned about a rash that developed on the girl’s face over the past week. On examination, you find a fine, scaly, pigmented plaque with pink and violaceous hues on her lower cheek. The lesion has a linear configuration. The patient and her family have a history of atopy, but the girl is well-appearing and has no systemic symptoms. View the photo …
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The patient is a 40-year-old male who presents to urgent care with lower-left back pain after an alumni soccer game during his high school reunion weekend. View the images taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
Read MoreJust 4 years ago, a Research Letter published by JAMA Internal Medicine painted an unflattering picture of the antibiotic prescribing habits in U.S. physician offices, urgent care centers, retail clinics, and emergency rooms.1 Urgent care took its lumps along with other settings—but in response, collectively, also took the issue seriously and set to work on correcting course. In introducing their Antibiotic Stewardship program, The Urgent Care Association and the College of Urgent Care Medicine noted …
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