Practice Management
The patient is an 8-year-old girl with a smattering of brown to black lesions on her arms. They’re not painful or causing discomfort, but her mother is concerned because they look darker than the average freckle. Exam reveals small (less than 0.5 mm), round, hyperpigmented macules. View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. <
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The patient is a 60-year-old female with no past medical history presents with intermittent exertional chest pain for 4 days. She reports the pain is substernal with radiation to her left arm, is associated with nausea and diaphoresis, and is worsened by exertion. The patient says she experiences pain every 4-5 hours, but currently is pain-free. View the ECG taken and consider what your diagnosis and next steps would be. Resolution of the case …
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The patient is a 46-year-old female with pain in her wrist. She reports that she heard a “snap” when she put all her body weight on her left hand during an exercise class. View the images taken and consider what your diagnosis and next steps would be.
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Urgent message: A validated platform effective in performing rapid point-of-care tests for SARS-CoV-2 would be ideal for use in urgent care centers. While reports of false negative results with one system called the viability of such a platform into question, results of this study support the use of POC testing using self-collected nasal swabs. Bronson Elizabeth Delasobera, MD; Amanda Joy, PA; Masashi Waga; Rita Malley, MS; Anisha Patel, MS; Sarah Greenwood, PA; Jerry Creighton, RN; …
Read MoreSeasoned Eyes and ECGs Comparing ACS Decision Tools Does TMACS Stack Up? Cluing Patients in on Chest Pain Gender Differences in Chest Pain Assessment Duration of Chest Pain in Diagnosing MI Ivan Koay, MBChB, FRNZCUC, MD When It Comes to Reading ECGs, Experience Counts Key Point: Advanced practice practitioners (APP) in this study had a level of skill in ECG interpretation equal to first-year EM attendings. These skills could be utilized, potentially, as screening pathways …
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ABSTRACT Background: The HEART Score is an effective method of risk-stratifying emergency department patients with chest pain. The rate of major adverse cardiovascular events (MACE) in patients with moderate HEART score referred from an urgent care center (UC) for an expedited outpatient cardiology evaluation is unknown. Purpose: The primary outcome of this study was to examine the rate of MACE when patients with moderate HEART score were referred for expedited outpatient cardiology follow-up after evaluation …
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Urgent message: A growing body of evidence suggests increased cardiovascular risk with frequent cannabis use. With cannabis availability and legalization increasing, the urgent care provider must understand how it affects the risk for acute medical issues among frequent users. Bella Nagappan, MD and Susanne Demeester, MD INTRODUCTION Cannabis, or marijuana, is legal for recreational use in 11 states and medical use in 33 states.1 With this increasing availability and legalization, the urgent care clinician must …
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Urgent message: The risk in not “doing the math” with a patient’s risk factors is obvious for that patient. However, urgent care providers and operators also run significant legal risk when patients with multiple complaints present and there’s a bad outcome—even if the most pressing complaint is impossible to discern. Michael B. Weinstock, MD; David A. Farcy, MD FAAEM, FACEP, FCCM; and Ramin Vejdani, DO [This case was adapted from a chapter in the book Bouncebacks! …
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The patient is a 37-year-old male who presents with a red, round lesion with a fine, scaly plaque on his face which developed over the past month. He also reports seeing similar lesions on his scalp while combing his hair. None of the lesions are painful, though he describes them as “slightly itchy.” No history of injury to the area. View the image and consider what your diagnosis and next steps would be.
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The patient is a 44-years-old previously healthy male who presents with continuous, typical cardiac chest pain of a few hours’ duration, with no associated symptoms. He reports that this is a first-time occurrence. He also relays that he is a nonsmoker, nonalcoholic with no family history of heart disease. On physical examination, you find his vital signs are stable. Cardiac auscultation reveals normal first and second heart sounds with no murmurs. Labs reveal slightly elevated …
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