Practice Management
A 38-year-old female with no past medical history presents to an urgent care with right upper quadrant abdominal pain and chest tightness, worsening for 1 week. She reports that her chest tightness is associated with shortness of breath, and is worse when walking and lying on her side. She denies fever, cough, dysuria, headache, or weakness. View the ECG and consider what your diagnosis and next steps would be. (Case presented by Catherine Reynolds, MD, …
Read More
The patient is a 24-year-old male who reports to urgent care with right ankle pain after falling from a ladder while cleaning out the gutters at his parents’ home. He reports that he was only a few rungs up but that he landed “awkwardly” and immediately felt a sharp pain on the front of the ankle. He is unable to bear weight but denies any numbness or tingling. View the x-ray taken and consider what …
Read More
Remember the fall of last year—when the nation and world pined for an expedient end to 2020, as if such an arbitrary change as turning a page on the calendar could somehow reverse our collective fortune? Unsurprisingly when January 2021 arrived, all our woes were not magically and immediately remedied. In fact, the start of this year was among the most grim in U.S. history: nearly a quarter of a million new cases were being …
Read More
Urgent message: Chief complaints may lead the provider “off the trail” of a more urgent diagnosis. Anchoring bias occurs when relying too heavily on this first piece of information. Providers must remain vigilant for the subtle and nonspecific warning signs of pulmonary embolism. Ryan Hagan, PA-C and Christina Gardner, DHSc, MBA, PA-C INTRODUCTION Chief complaints are used to guide decision-making and may suggest an organ system, but a life-threatening condition may be found in a …
Read MoreLight Exercise and mTBI Asymptomatic Hypertension—What’s the Risk? Racial Factors in Pain Treatment Supplemental Oxygen in ACS Shorter Courses of Antibiotics for Pediatric CAP Who’s Behind that COVID-19 Mask? COVID-19 Infection in Healthcare Workers Light Exercise for Patients with Mild Traumatic Brain Injury (mTBI) Take-home point: There is no benefit for recovery in patients with mTBI randomized to light exercise compared with standard care. Citation: Varner C, Thompson C, de Wit K, et al. A …
Read MoreHistory: A 67-year-old female presents to urgent care complaining of one episode of syncope earlier in the day. No seizure-like activity was noted by the family and she returned to baseline within a minute. She has a past medical history of end-stage renal disease on scheduled hemodialysis, hypertension, diabetes, coronary artery disease, and chronic nausea. Medications include aspirin, insulin, amlodipine, hydralazine, ondansetron, metoclopramide, and amiodarone. View the ECG taken and consider what your diagnosis …
Read More
The patient is a 36-year-old man who presents with wrist pain after “hitting it on something.” Further history reveals that he punched a wall in a fit of anger and felt sharp pain immediately. He has no past medical history and takes no medications. View the images taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
Read More
Urgent message: The identification and global impact of the novel coronavirus has significantly challenged medical decision-making. Urgent care providers now consider the inclusion of the SARS-CoV-2-causing illness in their differential diagnosis when evaluating patients with signs and symptoms of an acute respiratory infection. Louis Costanzo, MD, MBA Introduction As of March 2021, there have been more than 28.6 million documented cases of COVID-19 in the United States, with the majority of cases those ages 18 …
Read MoreNeuro Effects of COVID-19 Melatonin and Children with Postconcussive Symptoms Pediatric, Sports-Related Concussion Acute Migraine in Children and Adolescents Emily Montgomery, MD and Kelsey Riggs, MS3 Neurologic Manifestations of COVID-19 Take-home point: COVID-19 has a variety of presentations that include neurologic manifestations—most commonly, headaches. Citation: Niazkar HR, Zibaee B, Nasimi A, Bahri N. The neurological manifestations of COVID-19: a review article. Neurol Sci. 2020 Jul;41(7):1667-1671. Relevance: More than 1/3 of patients with COVID-19 experience neurologic …
Read More
Urgent message: The approved use of monoclonal antibodies to treat patients who have COVID-19 may signal a shift from inpatient to outpatient care of infected individuals who do not require hospitalization. Urgent care facilities may be ideally suited to serve as treatment centers and to become destinations of choice for such patients. Lindsey Fish, MD Now that COVID-19 has been with us for over a year, we are in a much different position regarding the …
Read More