A Pregnant Mother Presenting to Urgent Care with Chickenpox

A Pregnant Mother Presenting to Urgent Care with Chickenpox

Urgent message: Failure to correctly diagnose and provide immediate treatment for varicella zoster virus (VZV) infection in pregnant patients can lead to life-threatening complications for the mother, and serious congenital malformations to the fetus. Samrana Arefeen, MD and Khalid Aziz, MD Introduction There are several types of skin lesions and rashes that are common during pregnancy. Some are benign and confer no risk to the expectant mother or the fetus. However, some are symptoms of …

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A 50-Year-Old Farmer with Flu-Like Symptoms

A 50-Year-Old Farmer with Flu-Like Symptoms

The patient, age 50, is a farmer who presents with flu-like symptoms—fever, chills, productive cough, myalgia, and pleuritic chest pain that developed over a few weeks. What worried him most, however, was a crusted lesion on his arm that was a large verrucous scaly plaque. View the photo and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

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Longitudinal Assessment: A Dent in the ABMS Armor?

With the volume of dissent against Maintenance of Certification (MOC) now at a fever pitch, American Board of Medical Specialties (ABMS) boards are finally making changes to their recertification programs with the intent of reducing the burden on physicians. The issue could not be more acute than in urgent care, where many UCA member physicians have been practicing for years. Working outside of their specialties of training and growing more distant from the best practice …

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Abstracts In Urgent Care – December 2018

The Year in Abstracts: Top Papers of 2018 for the Urgent Care Clinician Reviewed by Andy S. Barnett, MD  This has been an eventful year in the urgent care marketplace. Then again, you could say that at the end of most years in our dynamic, ever-growing industry. That begs the question, what did set 2018 apart from other years? Mergers and acquisitions, evolving technologies, and workplace trends certainly impact what you do every day. But …

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A 9-Year-Old Girl Who Choked on a Chicken Nugget

A 9-Year-Old Girl Who Choked on a Chicken Nugget

Case The patient is a 9-year-old girl who is brought in by her parents shortly after choking on a chicken nugget. They are concerned because even though she stopped gagging, she complains that it feels “like there’s something stuck in there.” View the images, ordered to rule out a lodged foreign body, and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page.

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Treating Patients Infected with Influenza Virus in the Urgent Care Setting

Treating Patients Infected with Influenza Virus in the Urgent Care Setting

Urgent message: As patients start to feel the effects of the 2018–2019 influenza season, urgent care centers can expect to see visits by patients with related symptoms increase. Providers must be prepared to identify and treat patients most at risk for complications and poor outcomes—armed with old standbys and a newly approved antiviral agent. Samantha Arnold, DO Introduction Last month, JUCM explored prevention, diagnosis, and testing for influenza. In this issue, we focus on management …

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A 73-Year-Old Woman with a 12-Day History of Palpitations

A 73-Year-Old Woman with a 12-Day History of Palpitations

Case The patient is a 73-year-old woman who presents to the urgent care center with palpitations she says she first noticed 12 days ago. There is no associated chest pain, shortness of breath, abdominal pain, or paresthesias. The patient states she takes warfarin, with recent INR of 2.2. Her personal medical history includes atrial fibrillation, and there is a history of heart disease within the family. Upon examination, you find: General: A&O, NAD, WNWD Lungs: …

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A 12-Year-Old Football Player with Sudden Hip Pain

A 12-Year-Old Football Player with Sudden Hip Pain

Case The patient is a 12-year-old boy who presents with sudden hip pain that started simultaneously with a “popping feeling” in the same hip. He reports that it started in the middle of his football game earlier in the day. 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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Post Sports Injury Burn Due to Inappropriate Use of Cryotherapy

Post Sports Injury Burn Due to Inappropriate Use of Cryotherapy

Urgent message: PRICE (protection, rest, ice, compression and elevation) treatment is often advised to patients as part of sports soft tissue injuries; however, incorrect use of cryotherapy may lead to complications. Amitesh Kumar, MD Introduction Cryotherapy involves application of ice on acute soft tissue injuries in the form of ice cubes, ice packs, ice towels, ice massage, frozen gel packs, ethyl chloride, and other chemical devices. The goal is temperature reduction of 10-15⁰ C1 to …

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An Urgent Care Approach to Influenza—Before Onset

An Urgent Care Approach to Influenza—Before Onset

Urgent message: The urgent care clinician must have a thorough understanding of different influenza types and strains, disease course, and preventive measures—including, but not limited to, vaccination—at the outset of flu season.   Introduction Influenza is most deadly in the very young, very old, and those with comorbid conditions. Typically, onset is rapid and seasonal, though patients may initially present with few or nonspecific symptoms. Complicating things further, there are many different strains of the …

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