Practice Management
Urgent message: Toddler’s fractures are a common cause of limp and failure to bear weight in children under 4 years of age. Recent research shows wide variation in management of these stable fractures, favoring a less conservative approach. Amy E. Pattishall, MD The case: A 14-month-old male is brought to your urgent care by his parents immediately after an injury to his right leg at the park. The boy was riding down the slide on …
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Urgent message: Musculoskeletal disorders result in costly, disabling outcomes for Americans—causing significant economic impact (work-related injuries, early retirement, days away from work) and representing a leading cause of chronic diseases nationwide. Frequently, the initial treating facility, which determines if the injured/ill patient is capable of returning to work or needs time away from work or modified duty, is an urgent care center. Ashley Clay, MSPAS, PA-C INTRODUCTION An estimated one in two adults older than …
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Urgent message: “Wilderness” medicine is less exotic than one would think. Patients with complaints that began during or after an outdoor outing in any season are likely to present to urgent care, making wilderness medical knowledge of paramount importance. Stewart Harsant, MMS, PA-C Introduction Every season holds its own unique appeal to those who love the great outdoors. Similarly, every season has its own distinct set of risks, ranging from gastrointestinal symptoms, dermatological conditions, …
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Urgent message: Nontraumatic heel pain is a common presenting complaint in urgent care. Knowing how to accurately diagnose and develop a treatment plan is important, as the course is typically prolonged. Katty Grand-Pierre, MD, CMSS, Frank Ida, BS, EMT-B, and Vincent D’Amore, MD, FACEP INTRODUCTION The heel can absorb 110% of body weight while a person is walking and 200% of body weight during running.1 While the most common cause is plantar fasciitis (PF), accounting …
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Urgent message: Familiarity with the schedule for immunization against pertussis, as well as expertise in diagnosing and prescribing treatment, should be within the urgent care provider’s capabilities—as should the ability to distinguish which patients require transfer to a higher-acuity setting. Ellen Laves, MD Microbiology and Immunity Pertussis is a toxin-mediated disease caused by the gram-negative coccobacillus Bordetella pertussis. Toxins produced by B pertussis impair ciliary clearance of pulmonary secretions through the paralysis of normally …
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Urgent message: Urgent care centers may offer opportunities to provide preexposure prophylaxis (PrEP) services for HIV due to large numbers of patients seeking testing and treatment for sexually transmitted infection. In the same sense, the urgent care center may also serve as an important ally in providing referrals for patients not currently linked to primary care services. Yeow Chye Ng, PhD, FNP-BC, NP-C, CPC, AAHIVE, Jack J. Mayeux, MSN, APRN, NP-C, and Thuy Lynch, PhD, …
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Urgent message: Patients who have had recent surgical procedures may present to urgent care centers for reasons ranging from seeking reassurance to presentation of life-threatening complications. Tracey Quail Davidoff, MD Introduction Patients often experience complications—or, at least as often, fear they’re experiencing complications—after a surgical procedure. While the surgeon is often the best person for them to consult, this may not be possible for a variety of reasons. Outpatient surgical centers are opening almost at …
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Urgent message: Urgent care providers often see acute public health emergencies due to easy patient accessibility. It is important to identify communicable disease rapidly to control any risk of a community outbreak. This article will focus on mumps, measles and varicella (chickenpox). Carmen N. Burrell, DO, Melinda J. Sharon, MPH, and Megan Kessell, BA In recent years, outbreaks of uncommon infectious diseases have occurred in schools and communities, due to increasing travel exposures, decreasing vaccination …
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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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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 flu. …
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