Approach to Fever and Drooling in Infants and Toddlers

Urgent message: Typical drooling is no cause for alarm in infants and toddlers. However, excessive drooling accompanied by fever or other various red flags could be signs of more serious concerns such as retropharyngeal abscess, Ludwig angina, or upper airway obstruction. Recognition should trigger a thorough evaluation by the urgent care provider.   Katherine P. Dureau, MD   CASE A 24-month-old previously full-term and vaccinated male presents to an urgent care center with 24 hours of fever with a maximum temperature of 102.5⁰F. The father also reports drooling, decreased oral …
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Head Injuries and Cirrhosis: Does everyone need a CT Scan?

Head Injuries and Cirrhosis: Does everyone need a CT Scan?

Urgent message: The decision of whether or not to image a patient with a head injury has significant implications—for the patient and the urgent care provider. Understanding which patients are at greatest risk for serious head injury, indications for testing, and options for management/disposition is essential. Brandon Godfrey, MD; Haylie Wiesner, BS; and John Shufeldt, MD, JD, MBA, FACEP Case A 47-year-old male with a history of alcohol abuse and cirrhosis presents to an urgent care center after hitting his head on a cement column during “a minor altercation” with …
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Concussion Management in Urgent Care: A Primer for Implementation

Urgent message: Sports-related concussions are particularly dangerous injuries due to their complex nature and difficulties associated with diagnostic and return-to-play decisions. Some of the most commonly employed assessment tools have been shown to be unreliable, leading to misdiagnoses. Guidelines for selecting more effective concussion assessment instruments and the use of such tests in urgent care settings are here suggested as an optimal framework for improved care.   Len Lecci, PhD, MA Introduction Millions of adults, adolescents, and children participate in sport-related activities that place them at risk for concussion. Among …
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Management of Acute Exacerbation of Chronic Low Back Pain in the Urgent Care Setting

Urgent message: A systematic approach to evaluating, diagnosing, and treating low back pain in the urgent care setting reduces unnecessary hospital visits, identifies red flag symptoms that warrant further diagnostic or neurosurgical evaluation, promotes returning to work quicker, and helps to reduce the number of opioid prescriptions that are prescribed for episodic exacerbation and/or chronic conditions. Ashley Clay, MS, PA-C Introduction Up to 80% of the United States population experiences back pain at some point; however, most complaints resolve within 1-4 weeks without any additional treatment aside from the initial …
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Tattoos and Piercings: What the Urgent Care Provider Needs to Know

 Urgent message: Tattoos and piercings are becoming commonplace, but patients who experience complications with these forms of body art may present to urgent care centers, as access to dermatology and plastics specialists frequently requires a referral or extended wait periods. The urgent care provider should possess a working knowledge about how tattoos and piercings are performed, how to recognize the complications, and how to treat them appropriately. Tracey Quail Davidoff, MD  TATTOOS Introduction The term tattoo is derived from the Tahitian word tattau, which translates “to mark.”1 Tattoos occur when …
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