Ashley Blachford, Author at Journal of Urgent Care Medicine

Does the OSHA General Duty Clause Encompass Psychological or Emotional Injury?

Urgent message: Despite tort law and emerging workplace policies validating how sexual harassment, workplace bullying, and toxic gossip can lead to emotional and psychological harm, currently the OSHA General Duty Clause imposes a responsibility only for employers to provide a workplace free of “death and serious physical injury.” Alan A. Ayers, MBA, MAcc The OSHA General Duty Clause, Section 5(a)(1) of the Occupational Safety and Health Act,1 states that an employer must provide each of …

Abstracts in Urgent Care – September 2020

Seasoned 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 …

A Multicenter Study of the Rate of MACE in Chest Pain Patients with a Moderate HEART Risk Score Referred from Urgent Care for an Expedited Outpatient Cardiology Evaluation

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 …

What’s New for ICD-10 in 2021?

It’s that time of year again. On October 1, 2020, the annual update to ICD-10 codes goes into effective. Just a reminder—there is no grace period. Use of deleted or invalid diagnosis codes will result in claim denial and delay payment. The ICD-10-CM Official Guidelines for Coding and Reporting FY 2021 (October 1, 2020 – September 30, 2021) have also been updated. These are provided by the Centers for Medicare and Medicaid Services with the …

Cannabis-Associated Myocardial Infarction in a Young Woman Without Other Cardiac Risk Factors

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 …

Left on the Bench at the Start of the Pandemic, Urgent Care Rebounds in a Big Way

If you worked in an urgent care center located anywhere but a major urban hotspot at the outset of the COVID-19 pandemic, it’s likely your business suffered. You may have even seen your team diminished or your business (we hope temporarily) closed. It didn’t have to be that way. Between testing patients for COVID-19 and treating others for whom there was no room at the emergency room, it should have been a shining moment for …

The Challenge of Inequity in Urgent Care Medicine: A Call to Action

Lindsey E. Fish, MD The young black couple walked into our urgent care clinic, eyes wide and filled with fear, hope, and expectation. Wrapped in her mother’s arms was their 3-day-old beautiful baby girl, a child born in the midst of two scourges—the COVID-19 pandemic that was sweeping our country and world, and the pandemic of racial inequity that was surfacing due to peaceful protests and violent riots occurring throughout our cities and rural communities …

A 41-Year-Old Woman with Multiple Complaints

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! …

A 37-Year-Old Male with an ‘Itchy’ Lesion on his Face

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.

Chest Pain in a 44-Year-Old Male: Is It Too Early for Emergent Coronary Intervention?

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 …