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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An Unusual Case of Third and Fourth Metacarpophalangeal Joint Dislocations Following a Fall

An Unusual Case of Third and Fourth Metacarpophalangeal Joint Dislocations Following a Fall

Urgent message: Metacarpophalangeal dislocations involving digits other than the thumb or index finger may be somewhat atypical, but are known to occur as a result of a fall on an outstretched hand—a common precedent to an urgent care visit. Familiarity with management of such injuries precludes the need to refer the patient. Leonard A. Powell, DO, MS, FACOFP, CMD and Chad E. Richmond, DO ABSTRACT Metacarpophalangeal (MCP) joint dislocations typically occur in a dorsal fashion …

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The Value of Repeat Vital Signs

The Value of Repeat Vital Signs

Joshua Russell, MD, MSc, FCUCM, FACEP I’m just going say it: we should repeat vital signs more often in urgent care. But from the odd looks I get whenever I work with a new medical assistant, I realize that asking for vitals to be rechecked isn’t common practice among my colleagues; it may even be frankly contrarian. So, before I lose you, I’ll concede that one set of vital signs is more than enough for …

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An 83-Year-Old Female with CHF, A-Fib, and New-Onset Confusion and Syncope

An 83-Year-Old Female with CHF, A-Fib, and New-Onset Confusion and Syncope

An 83-year-old female with past medical history of congestive heart failure and atrial fibrillation presents to urgent care with confusion and syncope. She reports intermittent dizziness, but denies chest pain or shortness of breath. There is no evidence of trauma on exam.               View the ECG taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. (Case presented by Jonathan Giordano, DO, MEd, McGovern …

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A 9-Year-Old Girl with a New Rash on Her Face

A 9-Year-Old Girl with a New Rash on Her Face

A mother brings her 9-year-old girl daughter to your urgent care center because she’s concerned about a rash that developed on the girl’s face over the past week. On examination, you find a fine, scaly, pigmented plaque with pink and violaceous hues on her lower cheek. The lesion has a linear configuration. The patient and her family have a history of atopy, but the girl is well-appearing and has no systemic symptoms. View the photo …

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Antibiotic Prescribing Patterns for Sinusitis in an Urgent Care and Convenience Care Setting: A Quality Improvement Project

Antibiotic Prescribing Patterns for Sinusitis in an Urgent Care and Convenience Care Setting: A Quality Improvement Project

Urgent Message: Inappropriate antibiotic prescribing in the outpatient setting has been a longstanding public health challenge. An educational session implemented in a large Midwestern healthcare system group of urgent care and convenience care clinics resulted in a statistically significant reduction in antibiotic prescribing for acute sinusitis and a statistically significant increase in antibiotic guideline adherence. Dr. Amy K. Rasmussen, DNP, FNP-C ABSTRACT Background: Inappropriate antibiotic prescribing in the outpatient setting is a longstanding problem and …

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When a Fever is Not a URI: If It’s Not in the Differential, It Won’t Be in the Diagnosis

When a Fever is Not a URI: If It’s Not in the Differential, It Won’t Be in the Diagnosis

Urgent message: Fever in patients presenting to UC is often attributable to viral infections, urinary tract infections, otitis media, cellulitis, or pneumonia. When the source is not apparent after the initial evaluation, however, it is important to expand the differential in order to avoid missing less common, serious diagnoses. Samidha Dutta, DO; Caleb Marsh, OMS-IV, UP-KYCOM; Michael Weinstock, MD CASE PRESENTATION A 74-year-old man with a history of Parkinson’s disease and diabetes presented with 2 …

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Abstracts in Urgent Care – November 2022

Abstracts in Urgent Care – November 2022

Fever: To Treat or Not to Treat? Distinguishing Viral from Bacterial Conjunctivitis Scapular Fractures and Blunt Chest Trauma in Children Sterile vs Nonsterile Gloves for Laceration Repair Bronchiolitis Care: An Update Antibiotic Stewardship and Children Post Paxlovid Rebound Ivan Koay MBChB, FRNZCUC, MD What Are the Consequences of Treating Adult Fever? Take-home point: Fever therapy in adults does not seem to affect the risk of death and serious adverse events. Citation: Holgersson J, Ceric A, …

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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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