Ivan Koay MBChB, MRCS, FRNZCUC, MD Quinolone Eardrops and Achilles Tendon-Related Outcomes Take-home point: Quinolone eardrops were associated with an increased risk of all-type tendon rupture, including Achilles tendon (AT), but not AT tendinitis. Citation: Tran P, Antonelli P and Winterstein A. Quinolone ear drops and Achilles tendon rupture. Clin Infect Dis. 2022; ciac709. Epub ahead of print September 6, 2022. Relevance: Systemic quinolones have been known to increase the risk of tendon rupture. Prior …
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A New 4-Year-Old Patient with Fever and Sore Throat After a COVID Exposure
Bradley L. Laymon, PA-C, CPC, CEMC PRESENTATION A mother brings in her 4-year-old, who has never visited your urgent care center before, with complaints of fever and sore throat. The mother provides the HPI. She explains that the child’s symptoms have been present for 2 days. During that time, the patient’s temperature rose to a high of 101.5°F (38.6°C). Ibuprofen has been effective in reducing the fever. The girl was exposed to COVID-19 at daycare …
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2023 Trends for Urgent Care
Urgent Message: Five trends will drive urgent care strategy in 2023, including its continued response to COVID-19, building bridges with the pediatric community, integration of urgent and primary care, integration of specialist services, and increased operational efficiency in response to staffing challenges. Alan A. Ayers, MBA, MAcc is President of Experity Consulting and is Practice Management Editor of The Journal of Urgent Care Medicine. As we embark upon 2023, year of the “rabbit” in the …
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Yes, You Can Remove Corneal Foreign Bodies and Rust Rings in Urgent Care
John J. Koehler MD, ABPM(OM) I trained in Emergency Medicine in the 1980s and learned to use a slit lamp as an intern; it’s a skill that continues to serve me to this day. We had “opti-spuds” to remove foreign bodies and “opti-burrs” to debride rust rings. This was considered a core skill in my training. This is why, when I started Physicians Immediate Care in 1987, I bought a slit lamp as well as …
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A 70-Year-Old Male Who Presents in a Confused State
A 70-year-old male presents to urgent care with confusion. On exam, the patient is tachypneic and is, indeed, confused but is able to follow commands. View the initial ECG 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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A 41-Year-Old Woman with a History of SLE and Sudden-Onset Sores on Her Limbs
A 41-year-old woman with a history of systemic lupus erythematosus presents for evaluation of painful areas that had developed on her upper, outer arms and lateral thighs over the past month. She reports that while the affected areas were initially smooth, some had begun to ulcerate. View the photo taken and consider what your diagnosis and next steps would be.
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A 35-Year-Old Male with a Soft Tissue Mass on His Finger
The patient is a 35-year-old male with a soft tissue mass in the mid index finger of his right hand. He reports that he noticed it only recently, and denies any other symptoms. View the x-ray taken and consider what your diagnosis and next steps would be.
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Evolution of the Urgent Care Staffing Model During the COVID-19 Pandemic
The scourge of the COVID-19 pandemic has affected urgent care practices deeply, beyond what you already know firsthand. In addition to fluctuations in patient visits, efforts to keep staff safe, and reorganizing locations to meet whatever need was greatest at a given moment, the “typical” urgent care staffing model evolved at an accelerated pace between 2019 and today. The proportion of centers in which physician assistants and nurse practitioners treat patients with only remote …
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Facial Nerve Blocks in the Urgent Care Center
Urgent message: Often, patients that could safely be treated for lacerations in the urgent care center are referred to the emergency room due to the quest for expediency, or even providers being out of practice with treating such wounds on site during the COVID-19 pandemic. However, doing so contributes to the degradation of acuity in urgent care while delaying care and raising costs. Anesthesia for wound repair can be achieved in many ways, typically with …
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Cost-Effective Management of Deep-Vein Thrombosis
Urgent message: Utilization of validated scoring systems and clinical decision-making tools can enable the urgent care provider to manage many patients presenting with symptoms of deep-vein thrombosis in the urgent care center, reducing the need for costly referral to the emergency room. Daniel Eisner, DMSc, PA-C ABSTRACT Management of venous thromboembolism accounts for $10 billion in medical spending annually, with much of the cost attributable to emergency room visits. Conversely, managing VTE patients in the …
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