Practice Management
Case The patient is a 9-year-old girl who is brought in by her parents shortly after choking on a chicken nugget. They are concerned because even though she stopped gagging, she complains that it feels “like there’s something stuck in there.” View the images, ordered to rule out a lodged foreign body, and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page.
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Urgent message: As patients start to feel the effects of the 2018–2019 influenza season, urgent care centers can expect to see visits by patients with related symptoms increase. Providers must be prepared to identify and treat patients most at risk for complications and poor outcomes—armed with old standbys and a newly approved antiviral agent. Samantha Arnold, DO Introduction Last month, JUCM explored prevention, diagnosis, and testing for influenza. In this issue, we focus on management …
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Case The patient is a 73-year-old woman who presents to the urgent care center with palpitations she says she first noticed 12 days ago. There is no associated chest pain, shortness of breath, abdominal pain, or paresthesias. The patient states she takes warfarin, with recent INR of 2.2. Her personal medical history includes atrial fibrillation, and there is a history of heart disease within the family. Upon examination, you find: General: A&O, NAD, WNWD Lungs: …
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Case The patient is a 12-year-old boy who presents with sudden hip pain that started simultaneously with a “popping feeling” in the same hip. He reports that it started in the middle of his football game earlier in the day. View the image taken and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page.
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Urgent message: PRICE (protection, rest, ice, compression and elevation) treatment is often advised to patients as part of sports soft tissue injuries; however, incorrect use of cryotherapy may lead to complications. Amitesh Kumar, MD Introduction Cryotherapy involves application of ice on acute soft tissue injuries in the form of ice cubes, ice packs, ice towels, ice massage, frozen gel packs, ethyl chloride, and other chemical devices. The goal is temperature reduction of 10-15⁰ C1 to …
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Urgent message: The urgent care clinician must have a thorough understanding of different influenza types and strains, disease course, and preventive measures—including, but not limited to, vaccination—at the outset of flu season. Introduction Influenza is most deadly in the very young, very old, and those with comorbid conditions. Typically, onset is rapid and seasonal, though patients may initially present with few or nonspecific symptoms. Complicating things further, there are many different strains of the flu. …
Read MoreFrom ID Week: Outbreak-Related Hep A Infections Are on the Rise Key point: Hepatitis A infection may be evolving from common-source exposure to outbreak exposure. Urgent care clinicians can influence this phenomenon by recommending that at-risk adults receive immunization. Citation: Foster M, Hofmeister M, Yin S, et al. Changing epidemiology of hepatitis A virus infections—United States, 2009–2017. Oral Abstract Session. ID Week 2018. Available at: https://idsa.confex.com/idsa/2018/webprogram/Paper74176.html. Accessed October 8, 2018. Between 2007 and 2017, the …
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Case A 45-year-old woman presents with a complaint of “a brown spot” on her back. Upon examination, you confirm there is a reticular hyperpigmented patch of skin, which she says she noticed after using a heating pad to relieve myalgia after working in her garden. She confesses that she fell asleep with the heating pad on the area, she thinks for several hours. View the photo and consider what your diagnosis and next steps would …
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Case The patient is a 52-year-old man who presents to your urgent care center with lightheaded dizziness, which he says has been present for the past 3 days. It is worse with standing. He reports that he has been spending a lot of time in the sun lately. He denies chest pain, shortness of breath, abdominal pain, or paresthesias. He does not take any medications. His personal medical history untreated hypertension, and there …
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Urgent message: Seeking information beyond the stated history can prompt important information that informs the true diagnosis. This is especially true in patients with a complicated or potentially embarrassing history. Case Presentation A 59-year-old female with a past medical history of type 2 diabetes and hypertension presents to an urgent care facility with complaints of abdominal pain. She is well known to the urgent care staff. She is consistently noncompliant with medical care. Her hypertension …
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