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Working in an urgent care or emergency room setting in United States of America today isn’t for the faint of heart. Equal parts challenging, intense, and often overwhelming, such a pressure-packed and uncertain environment inherently includes a variety of medical conditions and situations.
In this lecture entitled Urgent Care: Cases and Clinical Pearls, Jennifer Bamford, MD, Assistant Professor of Family Medicine, University of Vermont Larner College of Medicine, Burlington, VT discusses an array of diseases and medical conditions that may confront clinicians, nurses, and medical professionals working in urgent care and emergency room settings. The approximately 52-minute lecture was recorded exclusively for AudioDigest on Aug. 12, 2021, using virtual teleconference software, in compliance with social-distancing guidelines during the COVID-19 pandemic.
While this lecture is ideal for Emergency Medicine physicians, clinicians, nurses, and other healthcare practitioners, it can also assist those working in the field of Family Medicine. Typically, many of the conditions and cases outlined in this lecture are referred to an Emergency Department.
When one thinks of a tick-borne illness, Lyme disease almost immediately comes to mind. But one other illness that’s seen an “uptick” of incidences in recent years, particularly in the state of Vermont, is known as anaplasmosis. Similar to ehrlichiosis in both its nature and presentation, anaplasmosis symptoms include fever, headache, myalgia, and abdominal pain. These symptoms can begin to manifest within days of infection—although the average incubation period is between one and two weeks in length.
“Symptoms of anaplasmosis are very flu-like, although with fewer respiratory symptoms,” explains Dr. Bamford. “Anaplasmosis may occur earlier after a bite than lyme disease.”
While a full 90 percent of anaplasmosis cases occur in the Northeast, Michigan, and Wisconsin, scattered cases can occur anywhere Lyme disease is also found—and a few cases have also been identified in New England and the Pacific Northwest. Like with many diseases, the elderly tend to fare worse when it comes to anaplasmosis outcomes. It is much less commonly diagnosed in children, who may appear asymptomatic or merely mildly symptomatic when they are infected.
Dr. Bamford also details treatment methods for anaplasmosis. When patients are treated with doxycycline, recovery is typically observed within a day or two of drug administration.
“Clinical improvement with doxycycline is usually extremely fast,” states Dr. Bamford. “Within 24 to 48 hours.”
The most common of all ovarian germ cell tumors, teratomas are dermoid cysts that can contain skin, hair, teeth, and mixed sebum (an oily substance produced in the sebaceous glands of the skin). Teratomas treatment typically involves surgery, with either a cystectomy or an oophorectomy being performed to remove the teratoma from the patient. Typically, a teratoma is not considered to be any kind of serious health concern—although there are exceptions.
“Most teratomas are benign, but around one percent can be malignant,” explains Dr. Bamford. “Most of the time they’re unilateral, but they can be bilateral and they can produce hormones.”
Teratomas can cause the female patient to experience urinary frequency and pain. Dr. Bamford details a case in which a musculoskeletal examination revealed tenderness in the right lumbar paraspinous region—and a resultant x-ray revealed a nonspecific abdominal gas pattern with a focal coarse area of irregular mineralization. Typically, teratomas are diagnosed via ultrasonography in younger women.
“They normally occur in women who are 10 to 30 years old,” says Dr. Bamford.
Dr. Bamford also addresses what she calls “the weird weakness”—Guillain-Barré syndrome. Named after French neurologists Georges Guillain and Jean Alexandres Barré, Guillain-Barré syndrome is a rare disorder in which a patient’s immune system essentially attacks his or her nerves. The condition may be triggered by an acute bacterial or viral infection, and it in turn sparks a rapidly progressive polyneuropathy that is accompanied by severe weakness—and sometimes paralysis. In order to prevent serious long-term damage, it’s important to diagnose and treat Guillain-Barré syndrome in its early stages of development.
“Thirty percent of patients will need respiratory support on a ventilator, and it usually progresses over two weeks,” explains Dr. Bamford. “The important thing is to treat this one early. You don’t want to miss this one.”
Treatment for Guillain-Barré syndrome typically involves intravenous immunoglobulins or plasma exchange and supportive care. Dr. Bamford advises that respiratory function should be monitored, along with blood pressure and cardiac function monitoring. She also notes that most patients progress for two weeks, plateau for two to four weeks, and then slowly improve.
In her lecture, Dr. Bamford also details a compelling case study involving a patient with Guillain-Barré syndrome. The patient presented with bilateral weakness and tingling in the arms and legs, problems lifting things above the head and getting up from the floor, and a lack of knee reflexes. A neurologic examination of the patient revealed areflexia and weakness of the bilateral hip flexors, hip adductors, elbow extensors, finger adductors, and finger extensors.
Listen to Dr. Bamford go into more detail about 10 less-common cases that may pop up in your Urgent Care ER, and how best to treat them, in this educational and invaluable lecture entitled “Urgent Care: Cases and Clinical Pearls.” You can also access AudioDigest’s Top 5 Family Medicine audio lectures anytime—and earn Family Medicine CME on your own schedule.
We also encourage you to explore AudioDigest Family Medicine CME/CE Gold Membership. Offering always-on, go-anywhere access to more than 150 expert lectures and 85 hours of listening, Gold Membership has been carefully designed to deliver the knowledge you need to provide unsurpassed care to your patients—anytime, anywhere. You can also earn more than 180 CME/CE credits on your own time and terms.