Practice Management
Joshua Russell, MD, MSc, FCUCM, FACEP Sophie was back with another one of her kids in tow. This was the fifth time in a month. I could almost hear my staff roll their eyes when she walked through the door. Even though she was a denizen of the clinic, I was about to meet her for the first time because I usually covered other sites. Although I was out of the loop, my medical assistant …
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Urgent message: The use of all-inclusive kits with compact, table-top analyzers provides a rapid quantification of HbA1c levels in patients. The use of these tests for in-house screening has the potential to increase the diagnoses of early or asymptomatic diabetes in young adults and under-served or overlooked populations. Jay H. Shubrook, DO; Jane M. Caldwell, PhD; and Lindsey E. Fish, MD Citation: Shubrook JH, Caldwell JM, Fish LE. HbA1c as screening/diagnosis for early or asymptomatic …
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The patient is a 55-year-old woman who presents with sudden-onset wrist pain in her right wrist. She reports that she is right-handed and played pickleball the day before onset, and that she is an avid bicyclist, but denies falling or experiencing any pain in the course of those activities. She says she “just woke up with it hurting.” View the image taken and consider what your diagnosis and next steps would be. Resolution of the …
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A 17-year-old high school lacrosse player presents to an urgent care center with a painful left ankle. He states that the pain started 2 days earlier when he twisted his left ankle (an inversion injury) while competing in a tournament. He says that he tried to continue to play, but the pain increased. He reports that the ankle swelled over the lateral aspect and that he has pain when he walks. He says that he …
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Urgent message: Urgent care centers play a vital role as a gateway into the health system for many children with acute care needs. Some of these needs require identification by the urgent care team, who may then need to stabilize the patient and initiate transfer to optimize clinical outcomes. Nikhil B. Shah, MD INTRODUCTION Pediatric office emergencies can be challenging for urgent care staff to manage. These high-stakes events do not occur frequently enough to …
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A 67-year-old male presents to urgent care complaining of pleuritic chest pain and dyspnea. He has a history of lung cancer, but denies known cardiac history. View the ECG taken and consider what your diagnosis and next steps would be. Resolution of the case is describe on the next page.
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A 23-year-old woman presents with a severely pruritic rash that developed on her leg and is spreading. The patient reports that 2 days prior to onset, she had gone hiking with her dog. She recalls going off-trail and brushing up against “woody vines and shrubs.” She denies sustaining insect bites and notes that the sun was particularly intense that day, so she wonders if this may be a sun reaction. She appears well and has …
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Download the article PDF: A 45-Year-Old with Chest Deformity A 45-year-old man presents with “asthma-like symptoms” that he says have “come and gone” for several years. He denies chest pain or a sense of racing heartbeat. A chest deformity is clear from observation. View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page.
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Urgent message: Low-dose naltrexone (LDN) is becoming more common as a treatment option for pain and thus will be increasingly prevalent in patients presenting to the urgent care setting. A thorough medication history, prioritization of non-opioid treatment options, and timely referral or transfer for severe uncontrolled pain are important considerations in the management of patients using low-dose naltrexone. Ting-Hsuan Chiang, MD; Kenneth Schmitt, BS; Ariana Nelson, MD INTRODUCTION Naltrexone is an opioid receptor antagonist approved …
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Download the article PDF: Abstracts in Urgent Care – July/August 2023 Lyme Disease Diagnosis in Children of Different Racial Groups Take-home point: Black children with Lyme disease were more likely to have arthritis rather than cutaneous findings at the time of diagnosis. Citation: Hunt K, Michelson K, Balamuth M, et al. Racial differences in the diagnosis of Lyme disease in children. Clin Infect Dis. 2023;76(6):1129-1131. Relevance: Erythema migrans (EM) is commonly felt to represent the …
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