Urgent message: It is common for patients with injuries to the upper extremity due to falls on outstretched hands to present to urgent care. As such, evaluation, appropriate imaging, and initial treatment should all be within a clinic’s capabilities.  Michael Bartuseck, MSN, ARNP, FNP-C, EP-C Introduction Urgent cares centers play an integral role in providing care for patients who have sustained injuries due to falls on outstretched hands (FOOSH). While complex anatomy of the wrist, hand, and elbow often lead to confusion and misdiagnosis of FOOSH injuries, the high prevalenceRead More
A 45-year-old man presents with bilateral ocular pain, excessive tearing, and bloodshot eyes. He reports that his symptoms began 2 days ago with the sensation of a foreign body lodged in his eye, and that his eyes have been unusually sensitive to light. He has not worn his contacts since the onset of symptoms. View the photo and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.Read More

Posted On February 1, 2018 By In Letter from the Editor-in-Chief

Expectations Disease

There are a few things from residency training that resonated so profoundly for me that they permeate everything I have done since. I will never forget my first delivery, not because I thought I would ever deliver babies in my practice, but because of the emotional and enduring collision of medicine and nature it represented for me. And who can forget the 36-hour shifts (now extinct) that I am quick to recount for young clinicians with the perfunctory “back in my day….” There were, of course, specific patients whose storiesRead More

Posted On February 1, 2018 By In Case Reports, Slider

Neck Rash on a 21-year-old Male

Urgent message: Acanthosis nigricans has a strong association with obesity and insulin resistance. Assessment involves a thorough physical exam to differentiate from other dermatosis, as well as full workup for insulin resistance. Early diagnosis in the urgent care setting, and treatment, will improve the appearance of acanthosis nigricans, but also the patient’s overall morbidity. Shailendra Saxena, MD, PhD and Bao Chau Nguyen, BS Introduction A 21-year-old Caucasian male presented for a circumferential hyperpigmented rash around the neck that began several months ago. History Past medical history was significant for morbidRead More
The patient is a 20-year-old female who presents with sudden onset of left sided chest pain. A collegiate cross-country runner, she reports that she also felt lightheaded when lacing up her running shoes earlier in the day. View the image taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.Read More

Posted On February 1, 2018 By In Abstracts

Abstracts in Urgent Care – February 2018

Revisiting Parameters for Treating Hypertension Key point: New guidelines have lower thresholds for diagnosis and treatment of hypertension. Citation: Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/ AGS/APhA/ASH/ASPC/ NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. [Epub ahead of print November 13, 2017] The 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines provide guidance for the prevention, detection, evaluation, and management of hypertensionRead More
The patient is a 51-year-old man with shortness of breath and an intermittent burning sensation in his chest. His symptoms began 2 days ago. Upon exam, you find: General: Alert and oriented Lungs: CTAB Cardiovascular: RRR without murmur, rub, or gallop Abdomen: Soft and NT without r/r/g View the ECG and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page.Read More
In the year 2000, Google famously adopted the corporate code of conduct motto, Don’t Be Evil to represent its approach to both business and workplace behavior. At the time, the approach seemed sensible, but today it feels strikingly out of touch. It’s a low bar that misses the mark on one of the most pressing issues of our time: respect and freedom from harassment, at work, at home, and at play. Don’t be evil is simply not good enough anymore. The ugliness of workplace culture—and, in particular, discrimination and harassmentRead More