Playing in the Band

Playing in the Band

I got my first guitar when I was 14. It was an Alvarez acoustic with an electric pick-up, and I played it every day—at least for a while. I thought it would make me cool and make the girls take notice. But after about a year, when neither of those things had happened, I just about gave up the guitar for good. There simply wasn’t much joy in always playing alone. What revived and has …

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Addressing Without Managing: Defusing the Ticking Time Bombs in Urgent Care

Addressing Without Managing: Defusing the Ticking Time Bombs in Urgent Care

In the world of urgent care, it’s assumed that we exist to provide immediate, episodic care for discrete problems. The sore throat, sprained ankle, and laceration are our bread and butter. However, we do not practice in a vacuum. We share patients with other clinicians who longitudinally follow and manage their multiple comorbidities. Additionally, for the growing number of patients without a primary care provider, we commonly serve as the sole point of contact with …

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No Troponin, No Problem: Reimagining Chest Pain Assessment in Urgent Care

No Troponin, No Problem: Reimagining Chest Pain Assessment in Urgent Care

Most urgent care providers loathe when a patient checks in with chest pain because, typically, they are presenting because they’re worried about a heart attack, and we’re worried we don’t have the tools to exclude this diagnosis. It’s no surprise that we’re met with consternation when we suggest they may have come to the wrong place for care. But is unavailability of troponin testing a worthy scapegoat? And is the practice of ED referral for …

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A Case of Late-Onset Diabetes

A Case of Late-Onset Diabetes

Urgent message: Previously undiagnosed diabetes in elderly patients is too frequently a precursor to the diagnosis of pancreatic cancer. Incidental and unexpected diagnosis of diabetes in older patients in urgent care, especially in normal or underweight individuals, should prompt a discussion about vigilant monitoring for other symptoms of malignancy and close follow-up with a primary care provider. Joshua Russell, MD, MSc, FCUCM, FACEP CASE PRESENTATION A 72-year-old woman with a history of hypertension presented to …

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Abstracts in Urgent Care – April 2022

Abstracts in Urgent Care – April 2022

Pediatric Pneumonia Signs and Symptoms of Cauda Equina Syndrome Removing ‘Stuck’ Rings Central vs Peripheral Acute Vertigo Zinc and Viral RTIs in Adults Nathan M. Finnerty, MD, FACEP; Joshua W. Russell, MD, MSc, FAAEM, FACEP; and Brett C. Ebeling, MD How Long Should Pediatric Pneumonia Be Treated? Take-home point: Lower-dose and shorter-duration amoxicillin treatment was noninferior to standard regimens for outpatient treatment of community-acquired pneumonia (CAP) in this trial. Citation: Bielicki JA, Stӧhr W, Barratt …

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When Walk-Ins Aren’t Welcome

When Walk-Ins Aren’t Welcome

Patient volume has always been a delicate topic between the clinical staff and administrators of urgent care centers. It’s no secret who stands where in this ongoing debate. Regardless of each side’s opinions, UC volume has been largely stochastic historically, fluctuating at its own whim without regard for who wishes it were higher or lower. Things are different now, though. Thanks to COVID, UC overcrowding has become the new ED overcrowding—ubiquitous. The large volumes of …

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An Underrecognized Epidemic: Toxic Positivity in Medicine

An Underrecognized Epidemic: Toxic Positivity in Medicine

Joshua Russell, MD, MSc, FCUCM, FACEP A colleague, Dr. Mitchell we’ll call him, told me about a PA that he was supervising recently who made a great catch in a patient with a swollen, blue finger: Achenbach syndrome. When the PA presented the presumptive diagnosis, Dr. Mitchell, unfamiliar with the condition, had to Google it before seeing the patient. Our PA was right, though. The patient walked out of clinic, happy to have a benign …

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Stepping Outside Yourself

Stepping Outside Yourself

Joshua Russell, MD, MSc, FACEP Until recently, I’ve had the rare luxury of working in busy urgent care centers where I was virtually always working side-by-side with another provider. However, with changes in my career and UC staffing models in the wake of the pandemic, I find myself working in single coverage situations the majority of the time nowadays. While I do miss the camaraderie of multi-coverage practice, I miss the unfettered access to a …

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The Last Hour Problem

The Last Hour Problem

It’s 8 pm and I’m 9 hours into a 10-hour shift when four new patients walk in. Even though I’m feeling drained, I smile warmly as each passes my workstation. I “eyeball” them each as they walk by; my grin persists because they all seem stable and my “TUR” for this shift in the emergency department is now only 45 minutes away. TUR (or “time until relief”) is a metric I continuously track with ruthless …

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The Unvaccinated Aren’t the Enemy

The Unvaccinated Aren’t the Enemy

Taylor wore her embroidered sorority sweatshirt and a mask below her nose when she came to see me. She was 19 and had just finished her freshman year at the local university. Her story was cliché, as well: cough, runny nose, and sore throat “that wouldn’t go away.” She’d been sick for 8 days and she’d come in to get antibiotics. This isn’t a story about antibiotic stewardship, though. “Have you been tested or vaccinated …

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