Telemedicine remains a hot topic of debate in urgent care circles. In fact, it seems like every urgent care conference I attend lately has a telemedicine track or expert panel. JUCM recently featured a point-counterpoint discussion between two industry leaders, Stanford Coleman, MD, MBA, FAAP and William Gluckman, DO, MBA, FACEP—whose opinions on the topic are as well-reasoned as they are divergent. So, let me add my two cents. The discussions and analyses I’ve been …
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An 80-Year-Old Man with Rhinorrhea, Cough, and Intermittent Dizziness
Case The patient is an 80-year-old man with history of hypertension and high cholesterol who presents with rhinorrhea and cough. On further history, he admits to 2 months of intermittent dizziness, not worsening. He denies any chest pain/discomfort, SOB, or sweating. No neuro symptoms. On exam, you find: General: A&O, NAD Lungs: Clear bilaterally Cardiovascular: Regular rhythm, without m,r,g Abdomen: Soft and nontender Ext: No edema or asymmetry, pulses are 2+ and equal in all …
Read MoreAbstract In Urgent Care-July 2019
Rush for Outpatient Stress Test Recommendation (Finally) Examined Key point: Rapid outpatient stress testing (ie, within 72 hours), which has long been recommended by the American Heart Association, did not decrease the short-term risk of major adverse cardiac events (MACE). Citation: Natsui S, Sun BC, Shen E, et al. Evaluation of outpatient cardiac stress testing after emergency department encounters for suspected acute coronary syndrome. Ann Emerg Med. April 5, 2019. [Epub ahead of print] The …
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A 48-Year-Old Woman with a Facial Lesion
Case The patients is a 48-year-old woman who presents with a single lesion on her cheek/face. As a healthcare worker herself, she says she is concerned that the excoriation might get infected. She denies knowing anything about the possible cause, but insists on receiving treatment. Notably, she is a frequent visitor to your urgent care center in spite of the fact that she is in excellent physical health. However, she has been diagnosed with borderline …
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Abdominal Pain in the Younger Adult: Let’s Not Forget Acute Diverticulitis
Urgent message: The differential diagnosis of abdominal pain is challenging because many symptoms and signs are nonspecific and because patients might often have concomitant medical conditions that could cause abdominal pain. Although diverticulitis is more common in older patients, failure to consider diverticulitis in the differential diagnosis of abdominal pain in the younger adult could lead to delayed diagnosis and undesirable complications. Fabrizia Faustinella, MD, PhD, FACP and L. Alexandre Frigini, MD Introduction Diverticular disease …
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A 2-Year-Old Girl with Leg Pain After Jumping on a Trampoline
Case The patient is a 2-year-old girl who is brought to your urgent care center by her parents several hours after jumping on a trampoline with her friend, but that she “seemed fine” when the mother picked her up to come home. View the images 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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Repetitive Motion Injuries: Urgent Diagnosis, Patient-Centered Management
Urgent message: Musculoskeletal disorders result in costly, disabling outcomes for Americans—causing significant economic impact (work-related injuries, early retirement, days away from work) and representing a leading cause of chronic diseases nationwide. Frequently, the initial treating facility, which determines if the injured/ill patient is capable of returning to work or needs time away from work or modified duty, is an urgent care center. Ashley Clay, MSPAS, PA-C INTRODUCTION An estimated one in two adults older than …
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A 27-Year-Old Marathon Runner with Epigastric Pain
A 27-year-old woman who has been training for a marathon presents to the urgent care center with epigastric pain. She states the pain is worse after she consumes tomato sauce or orange juice, and wonders if she may have reflux. She denies shortness of breath, exertional component, pleuritic pain, leg swelling, use of hormonal therapy, or sweating. No right upper quadrant pain. Improves with antacids. No FH or heart disease or other risk factors. Upon …
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A Construction Worker with Sudden Foot Pain After Stepping Into a Hole
Case The patient is a 45-year-old male construction worker who felt pain immediately after stepping down from a truck into a pothole. View the images taken and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page. Figure 1.
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A 9-Year-Old Girl with Sudden-Onset Sore Throat After a Meal
Urgent message: Sore throat and throat pain are common complaints in the urgent care setting. While infectious causes are the most common and the likely cause of the patient’s complaint, it is important to consider other causes. Linu Samuel, MD Introduction Sore throat and throat pain are common chief complaints across all ages in the urgent care setting. As clinicians who likely see these complaints multiple times a day, our differential diagnosis when walking into …
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