Is It Appendicitis? The Role of Clinical Scoring Systems, Labs, and Diagnostic Imaging

Is It Appendicitis? The Role of Clinical Scoring Systems, Labs, and Diagnostic Imaging

Urgent message: Ultrasound can provide essential data in the urgent care evaluation of suspicion of acute appendicitis. Facilitating a rapid diagnosis allows for immediate and appropriate decisions regarding management. Andrew Alaya, MD, MSc INTRODUCTION Appendicitis is thought to be the result of luminal obstruction due to various etiologies (such as lymph node hyperplasia, coprolites, or parasites) which lead to increased mucus production and bacterial overgrowth. This results in wall tension and eventually necrosis and potentially …

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Repairing Parallel Lacerations in the Urgent Care Center

Repairing Parallel Lacerations in the Urgent Care Center

Urgent message: Parallel lacerations or those that simply occur in close proximity pose a unique challenge for the urgent care clinician. Repairing either wound without inflicting further trauma on the other(s) requires both skill and familiarity with performing the appropriate technique. Patrick O’Malley, MD The Problem Lacerations in close proximity pose a unique challenge for the urgent care clinician. This situation is often encountered in the unfortunate setting of patients engaged in “cutting” behaviors. Narrow …

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Mysterious Skin Lesions in a Horse Trainer

Mysterious Skin Lesions in a Horse Trainer

Urgent message: Medical histories can help inform diagnosis, but clinicians must ensure their decisions are not swayed by erroneous historical elements or cognitive biases. Candace Walkley, MD and Kyle Swanson, OMS-3 INTRODUCTION Staphylococcus aureus and Streptococcus pyogenes may cause acute and inflammatory infections of the soft tissue in immunocompetent patients. However, patients with indolent and progressive lymphocutaneous infections should be evaluated for atypical bacterial and fungal pathogens. CASE PRESENTATION In March 2021, a 57-year-old healthy …

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Getting the Most Out of Your Urgent Care Google Ads Budget in 2022

Getting the Most Out of Your Urgent Care Google Ads Budget in 2022

Urgent message: As urgent care volume has dropped from pandemic highs, the average cost per click of Google Ads for searches related to “urgent care” has gone up—often considerably.” Advertisers need to understand the factors that affect these costs in order to optimize their budgets. Ira Pasternack The Google Ads Auction Framework Google Ads is built on an auction model that determines the cost of “clicks.” Every time a search occurs, Google uses an algorithm …

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Are Food/Drug Retailers Hiding their Retail Clinic “Failures?”

Are Food/Drug Retailers Hiding their Retail Clinic “Failures?”

Urgent message: Over the past 15 years, the nation’s largest food, drug, and mass retailers have announced clinic initiatives with great fanfare. However, we’ve heard little as these initiatives have quietly retreated and re-trenched, coincidently during the same period that urgent care has boomed. Alan Ayers, MBA, MAcc is Senior Editor, Practice Management of The Journal of Urgent Care Medicine Retail clinics—does anyone care anymore? Given there’s not been an “industry” update tallying the number of …

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A 60-Year-Old Woman with Dark, Painful Plaques on Her Legs

A 60-Year-Old Woman with Dark, Painful Plaques on Her Legs

The patient is a 60-year-old woman who presents to urgent care after developing dark areas over both legs over the course of the past few days. They are extremely painful. On examination, there were violaceous and dark brown, retiform plaques, some depressed and some crusted, over the legs. The patient has a history of diabetes, hypertension, and chronic renal insufficiency for which she required hemodialysis. View the image and consider what your diagnosis and next …

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Case Report: Reoccurring Metatarsophalangeal Joint Pain

Case Report: Reoccurring Metatarsophalangeal Joint Pain

Urgent message: Acute or chronic hallux pain is a common complaint in urgent care. Due to the structure, several diagnoses can have similar presentation on history and exam. With this discussion, we examine a sesamoid stress injury. Sergio P. Ramoa, MD, MS INTRODUCTION The tibial (medial) and fibular (lateral) sesamoids are contained within the flexor hallucis brevis tendons along the metatarsal head.1 They have several roles such as absorbing weight, helping glide and reducing friction …

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Case of a Nonhealing ‘Sunburn’ on a Toddler

Case of a Nonhealing ‘Sunburn’ on a Toddler

Urgent message: Rashes are a common ailment, and their etiology can have overlapping appearances. In a case where rash does not improve with treatment, it is often necessary to reconsider the differential. Sergio Ramoa MD, MS INTRODUCTION It is common for providers to have difficulty diagnosing patients who present with rash due to the diverse appearances, as well as overlapping similarities, of different etiologies. Due to the extensive nature of rashes, this article will focus …

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A Novel Method for Blinding Reviewers to Gender of Proceduralists for the Purposes of Gender Bias Research

A Novel Method for Blinding Reviewers to Gender of Proceduralists for the Purposes of Gender Bias Research

Urgent message Gender bias, whether overt or subconscious, may be to blame for disparities in hiring practices, salary, and advancement in medical schools, the urgent care setting, and any healthcare workplace. Recognizing the value of gender-neutral assessment may not only “even the playing field,” but increase the likelihood of identifying the best candidates for clinical positions. Michael Pallaci, DO; Jennifer Beck-Esmay, MD; Adam R. Aluisio, MD, MSc; Michael Weinstock, MD; Allen Frye, NP; Ashley See, …

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When It’s More Than Just A Cough

When It’s More Than Just A Cough

Urgent message: Take vital signs and physical examination of the chest with the utmost importance when evaluating a patient with a cough. The common complaint of “cough” in the urgent care setting can be a symptom of a life-threatening pathology. Frank Schaller, DNP, APRN, FNP-C and Lauren Dunn, MSN, APRN, FNP-C INTRODUCTION Cough is a common complaint across healthcare settings including the emergency department (ED), urgent care, and primary care arenas—especially during influenza season.1 Cough …

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