Practice Management
A 55-year-old male presents to urgent care with progressive dyspnea for 2 weeks associated with lower extremity edema. The patient is afebrile, slightly tachypneic, with bilateral lower extremity edema on exam. An ECG is ordered. View the ECG and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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Urgent Message: As shortness of breath and edema are common in pregnancy, urgent care clinicians must distinguish patients with normal physiologic changes from those with emergent conditions like venous thromboembolism, hypertension, eclampsia, and cardiomyopathy. John Ramos, MMS, PA-C, CAQ-EM Key Words: Ambulatory Care; Differential Diagnosis; Dyspnea; Pregnancy Complications; Pregnancy Complications, Cardiovascular Abstract Background: Physiologic changes in pregnancy contribute to shortness of breath and edema. However, these symptoms can also be caused by serious etiologies including …
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Urgent Message: In adolescents presenting with persistent chest pain and systemic symptoms, clinicians should maintain a high index of suspicion for autoimmune etiologies such as systemic lupus erythematosus causing pericardial and pleural effusions. Asra Usmani, MBBS, MD; Ali Baidoun, MD; Aaron Mahoney, DO; Megan Sikkema, DO Key Words: Pericardial Effusion, Pleural Effusion, Systemic Lupus Erythematosus, Chest Pain, Adolescent Abstract Introduction: Systemic lupus erythematosus (SLE) is a chronic autoimmune condition that can affect multiple organ systems. …
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A 21-year-old male with no significant past medical history presents to urgent care with a 3-week history of progressive cough, night sweats, dyspnea, and chest discomfort. He denies sore throat, rhinorrhea, sinus congestion, hemoptysis, weight loss, wheezing, tobacco use, or illicit drug use. On examination, vital signs are within normal limits. The patient appears well and not in acute distress. Lung auscultation was clear bilaterally, and the remainder of the initial physical exam is unremarkable. …
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Urgent Message: Patients frequently utilize urgent care centers for testing and treatment of sexually transmitted infections. All clinicians can be a first line defense to control the spread and combat the current epidemic. Alexandra Faraj, PA-S; Nadesha Muniz, MS Ed, PA-C Key Words: Sexually Transmitted Infections; Chlamydia; Gonorrhea; Syphilis; Expedited Partner Therapy; Urgent Care Abstract The rise in sexually transmitted infections (STIs) in the United States is a major public health concern. Patients frequently utilize …
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Validation of Clinical Predictive Rules in Pediatric Testicular Torsion Take Home Point: In this study, the Testicular Emergency Score for Torsion (TEST) identifies a larger group of patients at low risk for testicular torsion suitable for safe management without Doppler ultrasound compared to the other clinical validation scores. Citation: Valdivieso-Castro M, Vázquez-Gómez L, Olabarri M, et. al. Clinical Prediction Rules for Identifying Children With Testicular Torsion: A Multicenter Prospective Study. Pediatr Emerg Care. 2025 Aug …
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A 60-year-old female presents to urgent care with palpitations that started abruptly 1 hour prior to arrival. She denies recent illness or cardiac history. An ECG is ordered. View the ECG and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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A 16-year-old male presents to urgent care accompanied by his father due to acute onset of fever, abdominal pain, fatigue, altered mental status, and a lower-extremity rash. Symptoms began earlier the same day. The patient denies recent upper respiratory symptoms, medication use, travel, or trauma. On physical examination, he appears acutely ill and febrile to 103.1°F (39.5°C). Neurologic assessment reveals altered mental status. Dermatologic exam shows retiform, violaceous purpuric plaques with maroon borders on both …
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Countless times over the last year I have heard variations on a “we can’t” theme. It’s a specific and focused “we can’t” related to the services we are not able to provide to our urgent care patients. “We can’t do that test.” “We can’t use that medication in clinic.” “We can’t have our medical assistants do that.” Sadly, it is purely a reflection of education and training. However, as opposed to responding with increased training …
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Urgent Message: This study confirms variable prescription rates among different ethnicities in Aotearoa, New Zealand, for COVID-19 antiviral medication despite efforts to reduce health inequities. M. Adrianne Pimentel, MBChB, MHlthLd, FRNZCUC Key Words: Antiviral Prescribing, COVID-19, Comorbidity Abstract Introduction: In Aotearoa, New Zealand, COVID-19 disproportionately increased mortality and morbidity outcomes in Māori and Pacific patients. In an effort to counteract these health inequities, the government aimed to increase access to COVID-19 antiviral medication for Māori …
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