Practice Management
Joshua Russell, MD, MSc, FCUCM, FACEP A colleague, Dr. Mitchell we’ll call him, told me about a PA that he was supervising recently who made a great catch in a patient with a swollen, blue finger: Achenbach syndrome. When the PA presented the presumptive diagnosis, Dr. Mitchell, unfamiliar with the condition, had to Google it before seeing the patient. Our PA was right, though. The patient walked out of clinic, happy to have a benign …
Read More
Urgent message: It is common for transgender patients to have a history of poor experiences with healthcare providers. As such, they may be less likely to have an ongoing clinical relationship with a primary care provider, making urgent care a likely destination when a need arises. Familiarity with issues facing adolescent transgender patients, in particular, can benefit both the provider and the patient. Timothy McGinnis and Emily Montgomery, MD THE CASE A 15-year-old transgender male …
Read More
The patient is a 36-year-old male with a history of tobacco and alcohol use who presents to urgent care with sudden-onset substernal chest pain and shortness of breath that began 1 hour prior to arrival. View the ECG taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
Read More
The patient is a 43-year-old male who presents with a painful collection of pus near his fingernail. He reported that it had developed over the past day. On examination, a large, yellow-green superficial pus collection was seen at the proximal nail fold with surrounding erythema and edema. The patient mentioned that he had a home renovation business and that it was common for him to experience mild injuries such as splinters on his hands. The …
Read More
The patient is a 47-year-old male who presents with a primary complaint of right ankle pain after a pick-up game of basketball. He reports he twisted his ankle when he landed on another player’s foot. View the images taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
Read More
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 …
Read More
Urgent message: Though not considered as at “at risk” for severe disease with COVID-19, children have suffered significant disruptions to educational and personal activities throughout the pandemic. Recognizing urgent care’s role in testing for the virus could show benefit for families and urgent care centers alike. Rita P. Nunag, MD; Francesca M. Darquea, MD; Claire Loiselle; and Magdy W. Attia, MD Citation: Nunag RP, Darquea FM, Loiselle C, Attia MW. COVID-19 testing pattern in a …
Read More
Urgent message: Cutaneous abscesses are common presentations in urgent care. While either methicillin-sensitive or methicillin-resistant Staphylococcus aureus accounts for up to 75% of skin abscesses, atypical organisms such as nontuberculous mycobacteria (NTMB) can also lead to abscess formation. Urgent care providers should be aware that the clinical presentation may be atypical and require specialized treatment. Rachel Hughes, MD and Erik Butler, DO CASE PRESENTATION A 26-year-old female with no known past medical history other than …
Read More
Urgent message: Fragile skin lacerations in geriatric patients require a different repair strategy from those in younger patients. Despite the increased complexity of their wounds, most elderly patients with lacerations can be appropriately managed in the urgent care center. Oscar D. Almeida, Jr., MD, FACOG, FACS and Amy Hunter, DNP, FNP-BC, MSN-RN INTRODUCTION Skin tears form a subcategory of traumatic lacerations frequently affecting older adults. A study that searched Medline and Cochrane Reviews found that …
Read More
The Importance (or Not) of High BP Readings Learning While Driving—Does It Work? Considering Sucralfate in Pediatric Oral Ulcers Osteopathic Manipulation for Low Back Pain Safety of Oral Corticosteroid Bursts in Children Nathan M Finnerty, MD FACEP and Brett C Ebeling, MD Do High Blood Pressure Readings Matter? Take-home Point: Elevated blood pressure readings in the emergency room were not associated with an increased risk of poor cardiovascular outcomes in 2 years. Citation: McAlister F, …
Read More