Clinical

Case A 30-year-old woman visited urgent care complaining of a burning sensation on her tongue. At first, she had blamed it on a spicy meal, but the feeling didn’t go away and now she feels as though she isn’t able to taste food as usual. Looking back, she recalls that over a month ago she noticed a white plaque on her tongue. However, that had had disappeared within a day so she hadn’t thought much of it. View the photo and consider what your diagnosis and next steps would be.Read More

Case The patient is a 73-year-old male smoker who complains that he has had intermittent palpitations for the past 2 weeks. He denies chest pain, diaphoresis, fever, or dizziness. He uses home oxygen, 2 L/min, but denies any new shortness of breath. Upon exam, you find: General: Alert and oriented x 3 Lungs: Scattered minimal wheezing, which is symmetric Cardiovascular: Regular and tachycardic without murmur, rub, or gallop Abdomen: Soft and nontender without rigidity, rebound, or guarding Extremities: No pain or swelling, pulses are 2+ and equal in all fourRead More

Case A 21-year-old male presents with pain after dropping a piece of furniture on his right foot. He is physically able to bear weight during the assessment, though his pain is evident and he is unsteady when shifting his weight to the injured foot. 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

Urgent message: Snakebite envenomation is relatively rare, but immediate action upon presentation to the urgent care center—including quick and accurate identification, appropriate care, and sound decisions regarding transfer to the ED—maximize the chance for optimal outcomes.   Andrew Vang, DO   Introduction Snake venom poisoning is a complex medical emergency that is seen infrequently, but when encountered requires rapid recognition and urgent management. The following discussion will focus on appropriately identifying snakebites from indigenous venomous species in North America, Crotalid and Elapid snakes; initiating urgent management; and indications for transfer.Read More

Urgent message: Follow-up after a patient visit is essential to the continuum of care and to the perception of customer service. Especially in the urgent care setting, where providers may have no ongoing relationship with a patient, the most basic office practices (eg, collecting accurate and accessible contact information) can seem deceptively simple but are of critical importance. Jimmie Toler, MSN, NP-C, Emily E. Johnson, PhD, and Barbara J. Edlund, PhD, ANP, BC Introduction Continuum of care is synonymous with appropriate care. In the urgent care environment, this continuum includesRead More

Corny titles aside, MACRA/MIPS is creating a great deal of uncertainty and anxiety among physician practices, and urgent care centers are no exception. I have seen a lot of urgent care news sources, including this journal, referencing the latest updates from CMS (or recent articles published by other organizations), but urgent care-specific analysis is in short supply. I frequently hear colleagues say, “Medicare is such a small percent of my business, it’s just not worth the hassle.” Or is it? As with most government programs, complying with the rules indeedRead More

Urgent message: Superior mesenteric artery syndrome should be included in the differential diagnosis in children with abdominal pain and weight loss with rapid increase in linear growth. Ralph Mohty, MS3, and Michael Esmay, MD Introduction Abdominal pain is one of the most common complaints in childhood. A minor self-limited condition such as constipation or viral gastroenteritis is usually the cause, but more serious conditions need further evaluation and management.1 Chronic abdominal pain is a term used to describe intermittent or constant abdominal pain (of functional or organic etiology) that hasRead More

Finding New Pathways that Protect Head Injury Patients Key point: Using an EEG-based biomarker in adult patients has potential benefit. Citation: Hanley D, Prichep LS, Bazarian J, et al. Emergency department triage of traumatic head injury using a brain electrical activity biomarker: a multisite prospective observational validation trial. Acad Emerg Med. 2017;24(5):617-627. Prior studies estimate that traumatic head injury (TBI) accounts for over 2.5 million ED visits annually in the U.S., also revealing that ED visits for TBI have increased 29% from 2006 to 2010—a time when overall ED visitsRead More