A 46-Year-Old Woman with a Painful, Erythematous Plaque on Her Leg

A 46-Year-Old Woman with a Painful, Erythematous Plaque on Her Leg

The patient is a 46-year-old female who presents with a painful, erythematous, indurated plaque on her lower leg. She reports that it developed over the past month. At first she attributed the pain to “a bump” of unknown origin, but as the area of red skin expanded she became concerned that she became concerned, as she reports a history of deep-vein thrombosis.               View the image taken and consider what your diagnosis and next steps …

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A 34-Year-Old Female with a Syncopal Episode but No Remarkable History

A 34-Year-Old Female with a Syncopal Episode but No Remarkable History

A 34-year-old female with no reported medical history presents to urgent care after a syncopal episode. She describes standing up rapidly to answer the phone, followed by a sensation of lightheadedness and nausea with subsequent collapse. On evaluation, her vital signs are normal, she appears well, and she is currently asymptomatic. View the ECG taken and consider what your diagnosis and next steps would be. (Case presented by Tom Fadial, MD, The University of Texas …

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IgA Vasculitis in Children: Beyond the Rash

IgA Vasculitis in Children: Beyond the Rash

Urgent message: This is the urgent message about a truly urgent case presentation concerning a pediatric patient in an urgent care center. Diana Sofia Villacis Nunez, MD; Amit Thakral, MD, MBA; and Pareen Shah, MD CASE PRESENTATION A 12-year-old previously healthy female presents with a 5-day history of lower extremity rash and low-grade fever (100.6°F). A month earlier, she had a self-resolving viral upper respiratory infection. The rash is described as mildly pruritic, dark red …

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A Crisis of Trust

The conversation was going nowhere. After 15 minutes of explaining my concerns about the possibility of COVID-19, the lack of indication for antibiotics, the unreliability of rapid testing, I was no closer to satisfying my patient, Mrs. Fletcher, than when I first introduced myself. Joan Fletcher was a 40-something working mother of three who came to urgent care on a mission, as many patients do. The reason for her visit: an antibiotic prescription and a …

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Building the Body Up Just to Break the Body Down: A Look Into Black Market Substance Use Among Young Athletes and Bodybuilders

Building the Body Up Just to Break the Body Down: A Look Into Black Market Substance Use Among Young Athletes and Bodybuilders

Urgent message: Many performance-enhancing medications not currently approved by the FDA remain undetectable in basic urine specimens collected in the urgent care setting. If there is suspicion of any form of illicit substance use, the inquiry of specific supplements/agents is key, as side effect profiles are often vast and wide. Rachael M. Poff, PA-C and Christina E. Gardner, DHSc, MBA, PA-C INTRODUCTION Selective androgen receptor modulators (SARMs) constitute a class of medication that has become …

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An Atypical Presentation of Thyroid Storm: A Stark Yet Potentially Lethal Diagnosis

An Atypical Presentation of Thyroid Storm: A Stark Yet Potentially Lethal Diagnosis

Urgent message: Unmanaged hyperthyroidism can cause any number of acute conditions that would drive a patient to visit an urgent care center. Further, thyroid storm can mimic several life-threatening events. Early recognition of the correct diagnosis is essential to raising the likelihood of a positive outcome—and protecting the patient from self-harm. Amrita Mahajan, BA and Lindsey Fish, MD INTRODUCTION Thyroid storm is a rare, life-threatening complication of thyrotoxicosis, a condition caused by excess thyroid hormone. …

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Abstracts in Urgent Care – April 2021

Abstracts in Urgent Care – April 2021

Acetaminophen vs Ibuprofen in Children Optimizing Podcasts for Learning Dosing Ketorolac IV in Renal Colic Torus Distal Radius Fractures Avulsion Fractures of the Fifth Metatarsal Base COVID-19 and ECGs Long-Term Sequelae of COVID-19 COVID-19, Zinc, and Vitamin C Use of Acetaminophen and Ibuprofen for Fever and Pain in Young Children Take-home point: Acetaminophen and ibuprofen are both safe for short-term treatment of pain and fever in children under 2 years of age. Ibuprofen produces more …

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Chin Lacerations in Children—A Call for Caution

Chin Lacerations in Children—A Call for Caution

Urgent message: Adhesive repair for skin lacerations in pediatric patients is a viable (sometimes preferable) option—under the right circumstances. Careful consideration is warranted when the wound is to the chin. Joshua Sherman, MD and David Mathison, MD, MBA INTRODUCTION The use of adhesive repair in lieu of sutures for the management of minor lacerations has become increasingly commonplace.1 When used correctly, cosmetic outcomes are similar and may be superior to suture repair in certain situations. …

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Implementing Clinical Practice Guidelines in Adults with Hypertension: An Effective Practice Change in Urgent Care

Implementing Clinical Practice Guidelines in Adults with Hypertension: An Effective Practice Change in Urgent Care

Urgent message: Too often, patients first learn that they have hypertension secondary to an unrelated presenting complaint—often, in the urgent care setting. Improving adherence to treatment guidelines may improve management and, ultimately, outcomes. Jennifer Iacovo, DNP, APRN, FNP-C; Bonni Cohen, PhDc, DNP, APRN, ANP-C, FNP-C, CHFN, CNE, FAANP; and Judith Butler, DNP, CNM, WHNP, CNE Abstract Background: There are approximately 100 million adults in the U. S. with hypertension (HTN); almost half go undiagnosed. The …

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