A 17-Year-Old Male with Pain and Swelling in His Thumb

A 17-Year-Old Male with Pain and Swelling in His Thumb

The patient is a 17-year-old male who presents with pain and swelling in his left thumb. He reports that he fell off an all-terrain vehicle while “mudbogging,” bending the thumb back when he reached out to break his fall. View the image taken and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page.

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A 6-Year-Old Boy with Foot Pain After Tripping a Day Earlier

A 6-Year-Old Boy with Foot Pain After Tripping a Day Earlier

The patient is a 6-year-old boy who cried out in pain after jumping off the fourth step of the stairs in his house yesterday, landing hard on his feet. His mother reports that he has been limping ever since. She applied ice at home, hoping the pain would resolve overnight. It did not. On exam, you note the pain is located at the base of the first/second metatarsal. View the images taken and consider what …

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A 70-Year-Old Man with Hand Numbness and Pain

A 70-Year-Old Man with Hand Numbness and Pain

The patient is a 70-year-old male who presents to urgent care with numbness, pain, and difficulty opening his hands. His son, who drove his father to the appointment, notes that the skin also looks “bunched up in places.” The physician also observes what look like raised scars. The thumb and index finger seem unaffected. Upon questioning, the patient says he started noticing smooth nodules “a couple years ago.” He attributed that to his many years …

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Not Like Old Times

The first time I wrote this column was for the inaugural issue of JUCM in October 2006. Today I could reflect on how much has changed around us, yet how much has stayed the same, but you know…no one really cares about what’s happened since 2006. What we really care about is today, and tomorrow. What’s happening right NOW, and what’s going to happen NEXT. And that’s the inspiration for the 2020 Convention. Yep, I’m …

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Urgent Identification and Management of Postsplenectomy Sepsis

Urgent Identification and Management of Postsplenectomy Sepsis

Urgent message: Asplenic individuals have a rate of severe infections 2-3 times higher than the general population. Postsplenectomy sepsis should be considered in patients with impaired splenic function who present with a fever. Megan L. Lawson, PA-C and Christina Gardner, DHSc, MBA, PA-C CASE PRESENTATION A 45-year-old male presented to the urgent care with 18 days of sinus pain and congestion unresponsive to two courses of antibiotics, cefdinir and levofloxacin. Past surgical history revealed a …

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Ringing in 2020 with CPT Changes

It’s that time of year again. The American Medical Association has implemented the 2020 Current Procedural Terminology (CPT) code set. This year we have 394 changes: 248 additions, 71 deletions, and 75 revisions. All changes took effect on January 1. While the impact to urgent care is minor, several items bear highlighting Health Behavior Assessment and Intervention The codes in the Health Behavior Assessment and Intervention section are used to report services provided to improve …

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A Blistering Rash in an Otherwise Healthy 9-Year-Old Boy

A Blistering Rash in an Otherwise Healthy 9-Year-Old Boy

Urgent message: Impetigo is one of the most common skin infections in children, and can have a variable presentation. As such, it is essential that the urgent care provider be able to recognize this common skin infection, and to know the treatment options. Aimy T. Patel, MD, FAAP, Allison Burris, MD FAAP, and Nirav Shastri, MD, FAAP, FAMIA, ABMS-CI CASE PRESENTATION History A 9-year-old otherwise healthy boy presents with a 1-week history of an itchy …

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Keep Your Differential Broad, Especially During Flu Season

I’m phenomenally bad at gambling for a multitude of reasons. I bet small when I should bet large. I bet large when I shouldn’t even be playing the game. I’m especially terrible at roulette because when I pick a number, usually 22, I stick with it—much longer than I should. Each time the wheel stops, on any other number, I’m disappointed, sure. But that disappointment is quickly replaced with hope that the odds of lucky …

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Smoothing Ebb-and-Flow for Greater Staff Efficiency and Shorter Wait Times in Urgent Care

Smoothing Ebb-and-Flow for Greater Staff Efficiency and Shorter Wait Times in Urgent Care

Alan A. Ayers, MBA, MAcc is Chief Executive Officer of Velocity Urgent Care and is Practice Management Editor of The Journal of Urgent Care Medicine. Urgent message: Integration of healthcare delivery with mobile technology is leading more urgent care operators to embrace digital queuing systems that, given their ability to positively impact patient wait times, offer the promise of elevating the patient experience—and a distinct competitive advantage. In a perfect world, every patient who showed …

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