Clinical

Case This 42-year-old woman presents to your urgent care center with a 2-hour history intermittent dizziness and vomiting. She denies diarrhea or exposure to ill persons. Further history reveals that she has recently had some epigastric discomfort. In the exam room, she is alert and oriented. She seems comfortable, in fact. In addition, you find: Lungs: Minimal bilateral symmetric wheezing Cardiovascular: Regular rate and rhythm without murmur, rub, or gallop Abdomen: Soft and nontender without rigidity, rebound, or guarding. No epigastric discomfort with palpation Extremities: No pain or swelling ofRead More

The patient is a 37-year-old man who reports a two-day history of chest pain. It worsens with exertion, and when he lays back; it improves when he’s sitting or leaning forward. He denies any diaphoresis, radiation, or back pain. No pleuritic aspect. During the exam, he is alert and oriented, and in no distress. In addition, you find: Lungs: Clear to auscultation bilaterally Cardiovascular: Regular rate and rhythm without murmur, rub, or gallop Abdomen: Soft and nontender without rigidity, rebound, or guarding. No pulsatile abdominal mass Extremities: No pain orRead More

Urgent message: Urgent care providers are valued for their ability to treat nonemergent acute healthcare needs efficiently, but in so doing they are also well positioned to identify other, underlying healthcare issues such as hypertension. Introduction Heart disease is the leading cause of death in the United States and accounts for approximately 24% of all deaths.1 Many known risk factors are associated with heart disease, including high blood pressure. The Centers for Disease Control and Prevention estimates that 46,000 deaths each year may be prevented through effective treatment of hypertension,Read More

Urgent message: Urgent care providers must maintain a high index of suspicion for life-threatening conditions when assessing patients whose self-reporting of symptoms can be vague and nonspecific. Introduction Elderly patients often present for medical evaluation with vague complaints, oftentimes requiring the provider to obtain additional history from family and caregivers. Urgent care providers must maintain a high index of suspicion for life-threatening conditions based on non-specific symptoms. This case demonstrates the importance of recognizing a rare but serious entity: chronic salicylate toxicity in an elderly patient with altered mental status.Read More

Urgent message: Increasingly, patients with symptoms of acute infection run to their nearest urgent care center. As such, urgent care clinicians can contribute greatly to national efforts to save lives by stemming the growth of antibiotic resistance through good antibiotic stewardship. Introduction  Despite being a recent healthcare phenomenon, urgent care centers are responsible for a growing percentage of outpatient healthcare, with an estimated 160 million total annual visits at more than 9,300 sites in the United States.1,2 This is attributed to long wait times in hospital emergency departments for nonemergentRead More

New Data Measure Risks with Oral Corticosteroids Key point: Remember—all medications have risks! Citation: Waljee AK, Rogers MA, Lin P, et al. Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study. BMJ. 2017;357:j1415. This cohort study looks at patients with short-term steroid use (<30 days) and potential complications at 30 and 90 days out. Endpoints included fracture, sepsis, and blood clot. This study included 1.5 million patients 18-64 years of age. Over 1/3 used steroids in a 3-year period. TheRead More

CQI – Continuous Quality Improvement: The process by which an organization identifies a problem, plans action to address the problem, implements the plan, and reviews the results for effectiveness.       In healthcare, we commit to CQI in order to affect outcomes; we focus on systems and process and how inefficiencies and lack of integration lead to undesirable outcomes. We scrutinize and identify a problem and propose a plan to change the process to improve outcomes. Here’s a very simple example: A universally accepted clinical quality goal is to reduce theRead More

Case A 28-year-old woman presents to urgent care with elbow pain and swelling following a mechanical fall. She reports the pain is worse with range of motion. There is no shoulder or wrist pain, and no paresthesias. Exam confirms pain with palpation and decreased range of motion. The radial pulse is 2+; sensation distal to the elbow is grossly intact. The patient is afebrile, has a pulse of 104, respirations 20, and BP 124/80. View the image taken (Figure 1) and consider what your diagnosis and next steps would be.Read More